MEDICARE: DR. JOSEPH SONG MA, MD

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	208800000X	Urology Physician	83055	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2014018120	OTHER	MO	MISSOURI LICENSE NUMBER

General Provider Information

NPI Number	:	1487068904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH SONG MA, MD

Provider Business Mailing Address
First Line	:	1930 BRANNAN RD
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4310
Country	:	US
Telephone Number	:	678-284-4686
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 PLEASANT HILL RD STE 220
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-8030
Country	:	US
Telephone Number	:	770-979-9427
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	05/17/2019

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