Healthcare Provider Details

I. General information

NPI: 1164492203
Provider Name (Legal Business Name): JOHNNY WON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 MCGINNIS FERRY RD STE 100
SUWANEE GA
30024-1258
US

IV. Provider business mailing address

925 N POINT PKWY STE 130
ALPHARETTA GA
30005-5210
US

V. Phone/Fax

Practice location:
  • Phone: 678-347-2100
  • Fax: 678-473-9752
Mailing address:
  • Phone: 678-206-2589
  • Fax: 678-261-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number67187
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: