Healthcare Provider Details

I. General information

NPI: 1245935592
Provider Name (Legal Business Name): HA EUN CHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA CHO

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # HB-4000
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST # HB-4000
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204493
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number204493
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: