Healthcare Provider Details

I. General information

NPI: 1669648986
Provider Name (Legal Business Name): LILY GEM HWANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 HEMBREE RD STE 200
ROSWELL GA
30076-5710
US

IV. Provider business mailing address

5000 RIVERVIEW RD
SANDY SPRINGS GA
30327-4238
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-3331
  • Fax: 770-751-8421
Mailing address:
  • Phone: 312-952-7720
  • Fax: 678-803-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number062713
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number062713
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number062713
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: