Healthcare Provider Details

I. General information

NPI: 1205362993
Provider Name (Legal Business Name): BRICE HWANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SATELLITE BLVD NW STE 208
SUWANEE GA
30024-5050
US

IV. Provider business mailing address

1325 SATELLITE BLVD NW STE 208
SUWANEE GA
30024-5050
US

V. Phone/Fax

Practice location:
  • Phone: 762-257-6820
  • Fax: 762-257-6942
Mailing address:
  • Phone: 762-257-6820
  • Fax: 762-257-6942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2024-00250
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number95595
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101280997
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: