Healthcare Provider Details

I. General information

NPI: 1023528932
Provider Name (Legal Business Name): FIRST ONE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 LIVE OAK PKWY STE 103
NORCROSS GA
30093-1732
US

IV. Provider business mailing address

6000 LIVE OAK PKWY STE 103
NORCROSS GA
30093-1732
US

V. Phone/Fax

Practice location:
  • Phone: 770-447-4898
  • Fax:
Mailing address:
  • Phone: 770-447-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number2017153816
License Number StateGA

VIII. Authorized Official

Name: YONG KIM
Title or Position: MANAGER
Credential:
Phone: 770-447-4898