Healthcare Provider Details

I. General information

NPI: 1437940129
Provider Name (Legal Business Name): KWONPSYCHIATRY,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7046 ELMWOOD RIDGE CT
ATLANTA GA
30340-1873
US

IV. Provider business mailing address

4549 CYPRESS PARK DR
GAINESVILLE GA
30504-5995
US

V. Phone/Fax

Practice location:
  • Phone: 404-725-8881
  • Fax: 404-254-6523
Mailing address:
  • Phone: 404-725-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HYUN JUNG KWON
Title or Position: INCORPORATOR
Credential: NP
Phone: 404-868-8962