Healthcare Provider Details

I. General information

NPI: 1174457212
Provider Name (Legal Business Name): SANGMI NOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2889 OGDEN TRL
BUFORD GA
30519-7260
US

IV. Provider business mailing address

2889 OGDEN TRL
BUFORD GA
30519-7260
US

V. Phone/Fax

Practice location:
  • Phone: 470-938-5685
  • Fax: 470-938-5685
Mailing address:
  • Phone: 470-938-5685
  • Fax: 470-938-5685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN273760
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: