Healthcare Provider Details

I. General information

NPI: 1659041481
Provider Name (Legal Business Name): AGA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE STE 1620
ATLANTA GA
30308-2246
US

IV. Provider business mailing address

550 PEACHTREE ST NE STE 1620
ATLANTA GA
30308-2246
US

V. Phone/Fax

Practice location:
  • Phone: 404-885-7701
  • Fax:
Mailing address:
  • Phone: 404-885-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. JUNG WHUN SUH
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 404-881-1094