Healthcare Provider Details

I. General information

NPI: 1376610527
Provider Name (Legal Business Name): MOO O HWANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL ROAD EISENHOWER ARMY MEDICAL CENTER
FORT GORDON GA
30905-5741
US

IV. Provider business mailing address

300 W HOSPITAL ROAD EISENHOWER ARMY MEDICAL CENTER
FORT GORDON GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-8361
  • Fax:
Mailing address:
  • Phone: 706-787-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number37237
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number37237
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number37237
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: