Healthcare Provider Details

I. General information

NPI: 1871609511
Provider Name (Legal Business Name): CATHY HYUN PAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 SHIELDS RD
DALTON GA
30720-5013
US

IV. Provider business mailing address

2411 CROW VALLEY RD NW
DALTON GA
30720-6921
US

V. Phone/Fax

Practice location:
  • Phone: 706-278-6628
  • Fax: 706-278-6650
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number040975
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: