Healthcare Provider Details

I. General information

NPI: 1811536246
Provider Name (Legal Business Name): JUNGHWAN BANG PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 GWINNETT PLACE DR
DULUTH GA
30096-4708
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 TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP24669
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH9576
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016267
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT016267
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPTH9576
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberP24669
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: