Healthcare Provider Details

I. General information

NPI: 1780944835
Provider Name (Legal Business Name): HYUNG SEOK OH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST MSC 143
MACON GA
31201-2102
US

IV. Provider business mailing address

10494 NEW COVE RD MSC 143
ALPHARETTA GA
30022-6709
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-5500
  • Fax: 478-784-3550
Mailing address:
  • Phone: 770-380-2723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number005451
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number73379
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: