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General NPI Number Information
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NPI Number | 1881725620
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Entity Type | Individual
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Provider Name | JEAN YOUNG SONG MD
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 555 OLD NORCROSS RD SUITE 210
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-8716
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Country | US
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Telephone | 770-822-6360
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Fax | 678-442-7648
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Provider Business Mailing Address
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Address Line | 5795 RIVERWOOD DR NW
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-3726
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Country | US
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Telephone | 404-255-4842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 54344
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License Number State | GA
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