Healthcare Provider Details

I. General information

NPI: 1003879404
Provider Name (Legal Business Name): LINA S HWANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CENTERVILLE HWY STE 100
SNELLVILLE GA
30039-6457
US

IV. Provider business mailing address

3205 WOODWARD CROSSING BLVD STE F1039
BUFORD GA
30519-4938
US

V. Phone/Fax

Practice location:
  • Phone: 770-985-9957
  • Fax:
Mailing address:
  • Phone: 718-717-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number221779-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number221779
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51110
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number91697
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: