Healthcare Provider Details

I. General information

NPI: 1376869529
Provider Name (Legal Business Name): JOO HEE SEO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date: 04/23/2026
Reactivation Date: 05/21/2026

III. Provider practice location address

4275 JOHNS CREEK PKWY STE C
SUWANEE GA
30024-9117
US

IV. Provider business mailing address

4275 JOHNS CREEK PKWY STE C
SUWANEE GA
30024-9117
US

V. Phone/Fax

Practice location:
  • Phone: 912-513-1041
  • Fax: 762-316-2051
Mailing address:
  • Phone: 912-513-1041
  • Fax: 762-316-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number109463
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: