Healthcare Provider Details

I. General information

NPI: 1154399210
Provider Name (Legal Business Name): HOPE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MEMORIAL DR SUITE 112
STONE MOUNTAIN GA
30083-3148
US

IV. Provider business mailing address

5300 MEMORIAL DR SUITE 112
STONE MOUNTAIN GA
30083-3148
US

V. Phone/Fax

Practice location:
  • Phone: 678-704-0306
  • Fax: 678-704-0706
Mailing address:
  • Phone: 678-704-0306
  • Fax: 678-704-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number047542
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number015563
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number056406
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number056406
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number037841
License Number StateGA

VIII. Authorized Official

Name: SAMUEL JOHNSON
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 678-704-0306