MEDICARE: WONJIN RHI NP-C

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	363LF0000X	Family Nurse Practitioner	RN232644	GA

General Provider Information

NPI Number	:	1205488277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WONJIN RHI NP-C

Provider Business Mailing Address
First Line	:	3590 PEACHTREE INDUSTRIAL BLVD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4817
Country	:	US
Telephone Number	:	770-614-9799
Fax Number	:	770-614-9789

Provider Business Practice Location Address
First Line	:	3590 PEACHTREE INDUSTRIAL BLVD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4817
Country	:	US
Telephone Number	:	770-614-9799
Fax Number	:	770-614-9789

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

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	05/21/2021

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