MEDICARE: NAKYOUNG JUDY NAM M.D.

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	207K00000X	Allergy & Immunology Physician	59292	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518167436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAKYOUNG JUDY NAM M.D.

Provider Business Mailing Address
First Line	:	8200 ROBERTS DR STE 450
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-4115
Country	:	US
Telephone Number	:	770-952-8612
Fax Number	:	678-803-6944

Provider Business Practice Location Address
First Line	:	2089 TERON TRCE STE 250
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-1613
Country	:	US
Telephone Number	:	770-953-3331
Fax Number	:	678-801-4831

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	11/12/2020

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