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NPI Code Detail

MEDICARE: PIB FAMILY MEDICINE

MEDICARE: PIB FAMILY MEDICINE
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1801631247
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIB FAMILY MEDICINE
Provider Business Mailing Address
First Line : 2730 PEACHTREE INDUSTRIAL BLVD STE 101
Second Line :
City : DULUTH
State : GA
Zip : 30097-8627
Country : US
Telephone Number : 404-897-0684
Fax Number : 404-897-0729
Provider Business Practice Location Address
First Line : 2730 PEACHTREE INDUSTRIAL BLVD STE 101
Second Line :
City : DULUTH
State : GA
Zip : 30097-8627
Country : US
Telephone Number : 404-548-8850
Fax Number :
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : DR. SOOL KEE SONG
Credential : MD
Telephone Number : 404-897-0684
Provider Enumeration Date : 06/27/2024
Last Update Date : 08/21/2024

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Directions to “PIB FAMILY MEDICINE ” Practice Location

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