Healthcare Provider Details

I. General information

NPI: 1174432884
Provider Name (Legal Business Name): PHYSIO ELECTRODIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3159 WOODWARD DOWN TRL
BUFORD GA
30519-5023
US

IV. Provider business mailing address

3159 WOODWARD DOWN TRL
BUFORD GA
30519-5023
US

V. Phone/Fax

Practice location:
  • Phone: 470-505-3243
  • Fax:
Mailing address:
  • Phone: 470-505-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JUNGHWAN BANG
Title or Position: OWNER
Credential: DPT
Phone: 470-505-3243