Healthcare Provider Details

I. General information

NPI: 1205630712
Provider Name (Legal Business Name): HEEJIN YOON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 SATELLITE BLVD # 255-C
DULUTH GA
30097-4906
US

IV. Provider business mailing address

2250 SATELLITE BLVD # 255-C
DULUTH GA
30097-4906
US

V. Phone/Fax

Practice location:
  • Phone: 678-671-0099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN244544
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: