Healthcare Provider Details

I. General information

NPI: 1043552425
Provider Name (Legal Business Name): JENNY JIN SHIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

1760 HAYGOOD DR NE HSRB1 E356
ATLANTA GA
30322-3117
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-1112
  • Fax: 404-785-6288
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number75899
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: