Healthcare Provider Details

I. General information

NPI: 1508301326
Provider Name (Legal Business Name): JOHNATHAN HUH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1994 DEVONWOOD DR NE
ATLANTA GA
30329-2763
US

IV. Provider business mailing address

3772 HERITAGE PL
BUFORD GA
30519-7861
US

V. Phone/Fax

Practice location:
  • Phone: 770-377-3217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number8522
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: