MEDICARE: RIVER PARC INTERNAL 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
1	261Q00000X	Clinic/Center	RN193179	GA

General Provider Information

NPI Number	:	1912366931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER PARC INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	4855 RIVER GREEN PKWY STE 140
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-8333
Country	:	US
Telephone Number	:	678-417-0077
Fax Number	:	678-417-0337

Provider Business Practice Location Address
First Line	:	4855 RIVER GREEN PKWY STE 140
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-8333
Country	:	US
Telephone Number	:	678-417-0077
Fax Number	:	678-417-0337

Authorized Official
Title or Position	:	MD
Name	:	YOUNG KANG
Credential	:	M.D
Telephone Number	:	678-417-0077

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/18/2016

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