MEDICARE: AGNES H HAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1326002825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGNES H HAN

Provider Business Mailing Address
First Line	:	960 JOHNSON FERRY RD
Second Line	:	SUITE 515
City	:	ATLANTA
State	:	GA
Zip	:	30342-1611
Country	:	US
Telephone Number	:	404-252-7703
Fax Number	:	404-252-8863

Provider Business Practice Location Address
First Line	:	960 JOHNSON FERRY RD
Second Line	:	SUITE 515
City	:	ATLANTA
State	:	GA
Zip	:	30342-1611
Country	:	US
Telephone Number	:	404-252-7703
Fax Number	:	404-252-8863

Authorized Official
Title or Position	:	OWNER
Name	:	AGNES HAN
Credential	:	MD
Telephone Number	:	404-252-7703

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	12/27/2010

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