Provider Demographics
NPI:1881403665
Name:DIVINE MEDICINE LLC
Entity type:Organization
Organization Name:DIVINE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DACHM
Authorized Official - Prefix:DR
Authorized Official - First Name:PYUNGGANG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-703-9939
Mailing Address - Street 1:11180 STATE BRIDGE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7483
Mailing Address - Country:US
Mailing Address - Phone:770-703-9939
Mailing Address - Fax:770-200-1677
Practice Address - Street 1:11180 STATE BRIDGE RD STE 205
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-7483
Practice Address - Country:US
Practice Address - Phone:770-703-9939
Practice Address - Fax:770-200-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty