Healthcare Provider Details

I. General information

NPI: 1699165092
Provider Name (Legal Business Name): JUNEPARK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 PINE TREE RD NE UNIT 1219
ATLANTA GA
30324-5679
US

IV. Provider business mailing address

2700 PINE TREE RD NE UNIT 1219
ATLANTA GA
30324-5679
US

V. Phone/Fax

Practice location:
  • Phone: 770-622-1211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. JUNE PARK
Title or Position: PRESIDENT, CEO
Credential:
Phone: 678-524-1134