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General NPI Number Information
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NPI Number | 1548697220
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Entity Type | Organization
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Legal Business Name | AW BY CHUNG
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 303 SCENIC HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5672
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Country | US
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Telephone | 770-875-9555
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Fax |
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Provider Business Mailing Address
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Address Line | 303 SCENIC HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone | 770-875-9555
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Fax |
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Authorized Official
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Title or Position | LAC
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Name | HYERYUN CHUNG
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Credential | LAC
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Telephone | 770-875-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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