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NPI Code Detail

MEDICARE: EUNICE YOONHEE PARK CRNA

MEDICARE: EUNICE YOONHEE PARK CRNA
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
1163W00000XRegistered NurseRN261326GA
2367500000XCertified Registered Nurse AnesthetistAPRN-CRNA261326GA

General Provider Information

NPI Number : 1518813310
Entity Type Code : Individual
Provider Name (Legal Business Name) : EUNICE YOONHEE PARK CRNA
Provider Business Mailing Address
First Line : 304 SHAMUS WAY
Second Line :
City : JEFFERSON
State : GA
Zip : 30549-7646
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1000 MEDICAL CENTER BLVD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30046-7694
Country : US
Telephone Number : 678-312-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2026
Last Update Date : 06/23/2026

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