MEDICARE: SOOK HEE AHN MD

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	208000000X	Pediatrics Physician	048404	GA

General Provider Information

NPI Number	:	1578664827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOOK HEE AHN MD

Provider Business Mailing Address
First Line	:	251 MEDICAL WAY
Second Line	:	SUITE A
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2522
Country	:	US
Telephone Number	:	770-991-2176
Fax Number	:	770-991-2178

Provider Business Practice Location Address
First Line	:	251 MEDICAL WAY
Second Line	:	SUITE A
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2522
Country	:	US
Telephone Number	:	770-991-2176
Fax Number	:	770-991-2178

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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