Provider Demographics
NPI:1932889292
Name:JEONG, WOOSIG
Entity Type:Individual
Prefix:
First Name:WOOSIG
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 RUSSELLS POINT CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3064
Mailing Address - Country:US
Mailing Address - Phone:770-878-3296
Mailing Address - Fax:
Practice Address - Street 1:6340 SUGARLOAF PKWY STE 125
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4331
Practice Address - Country:US
Practice Address - Phone:770-476-5877
Practice Address - Fax:770-476-5835
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist