Provider Demographics
NPI:1821455783
Name:SUNG, EUNJI AN (NP-C)
Entity type:Individual
Prefix:
First Name:EUNJI
Middle Name:AN
Last Name:SUNG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:EUN
Other - Middle Name:J
Other - Last Name:AN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2180 SATELLITE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4927
Mailing Address - Country:US
Mailing Address - Phone:404-480-0557
Mailing Address - Fax:
Practice Address - Street 1:1325 SATELLITE BLVD NW STE 1503
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4661
Practice Address - Country:US
Practice Address - Phone:404-470-0557
Practice Address - Fax:770-599-7964
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN224478363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily