Healthcare Provider Details

I. General information

NPI: 1942301338
Provider Name (Legal Business Name): JAE MATTHEW CHOI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 CITY CIR STE 1600
PEACHTREE CITY GA
30269-3125
US

IV. Provider business mailing address

2451 CUMBERLAND PKWY SE STE 3860
ATLANTA GA
30339-6136
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-8013
  • Fax:
Mailing address:
  • Phone: 404-803-1100
  • Fax: 404-803-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2019
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: