MEDICARE: ANNA JIN APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	APC010148	GA

General Provider Information

NPI Number	:	1174470793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA JIN APC

Provider Business Mailing Address
First Line	:	1148 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4263
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1148 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4263
Country	:	US
Telephone Number	:	678-824-4882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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