=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174432884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSIO ELECTRODIAGNOSTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2026
-----------------------------------------------------
Last Update Date | 09/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3159 WOODWARD DOWN TRL
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30519-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-505-3243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3159 WOODWARD DOWN TRL
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30519-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-505-3243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JUNGHWAN BANG
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 470-505-3243
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251E1300X
-----------------------------------------------------
Taxonomy Name | Clinical Electrophysiology Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------