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General NPI Number Information
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NPI Number | 1881403665
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Entity Type | Organization
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Legal Business Name | DIVINE MEDICINE LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 11180 STATE BRIDGE RD STE 205
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City | JOHNS CREEK
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State | GA
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Zip | 30022-7483
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Country | US
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Telephone | 770-703-9939
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Fax | 770-200-1677
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Provider Business Mailing Address
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Address Line | 11180 STATE BRIDGE RD STE 205
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City | JOHNS CREEK
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State | GA
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Zip | 30022-7483
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Country | US
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Telephone | 770-703-9939
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Fax | 770-200-1677
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Authorized Official
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Title or Position | DACHM
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Name | DR. PYUNGGANG CHO
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Credential |
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Telephone | 770-703-9939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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