Healthcare Provider Details

I. General information

NPI: 1427674407
Provider Name (Legal Business Name): JUN H SONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 N DECATUR RD STE 701
DECATUR GA
30033-6135
US

IV. Provider business mailing address

2675 N DECATUR RD STE 701
DECATUR GA
30033-6135
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3184
  • Fax:
Mailing address:
  • Phone: 404-778-3184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number111341
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number111341
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: