Healthcare Provider Details

I. General information

NPI: 1982287496
Provider Name (Legal Business Name): MED FIRST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CARRIAGE OAKS DR
TYRONE GA
30290-1684
US

IV. Provider business mailing address

160 PARK HAVEN LN
TYRONE GA
30290-1722
US

V. Phone/Fax

Practice location:
  • Phone: 316-570-0392
  • Fax:
Mailing address:
  • Phone: 316-570-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONGJIN YOON
Title or Position: ATTENDING PHYSICIAN
Credential: M.D.
Phone: 316-570-0392