Healthcare Provider Details

I. General information

NPI: 1639758550
Provider Name (Legal Business Name): JOSHUA HEEJAE CHOI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W ATHENS ST
WINDER GA
30680-1786
US

IV. Provider business mailing address

PO BOX 459
COLBERT GA
30628-0459
US

V. Phone/Fax

Practice location:
  • Phone: 706-788-3234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO-06678
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number111524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: