Healthcare Provider Details

I. General information

NPI: 1982527487
Provider Name (Legal Business Name): JAYOUNG RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 EAGLES NEST CIR
AUBURN GA
30011-2563
US

IV. Provider business mailing address

532 EAGLES NEST CIR
AUBURN GA
30011-2563
US

V. Phone/Fax

Practice location:
  • Phone: 870-877-1913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN328632
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: