Healthcare Provider Details

I. General information

NPI: 1063024404
Provider Name (Legal Business Name): PAUL SUK HWANGBO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW STE 2055
ATLANTA GA
30309-1721
US

IV. Provider business mailing address

3400 OLD MILTON PKWY STE C425
ALPHARETTA GA
30005-3746
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-5699
  • Fax:
Mailing address:
  • Phone: 770-343-8760
  • Fax: 770-664-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10221
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: