Healthcare Provider Details

I. General information

NPI: 1699699389
Provider Name (Legal Business Name): ANDREW JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 INMAN VILLAGE PKWY NE STE 220
ATLANTA GA
30307-5502
US

IV. Provider business mailing address

3115 TOUCHTON CT
DULUTH GA
30097-4399
US

V. Phone/Fax

Practice location:
  • Phone: 541-727-8598
  • Fax:
Mailing address:
  • Phone: 541-727-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC010535
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: