Individual
JOHN IN-TAEK SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
960 JOHNSON FERRY RD STE 335, ATLANTA, GA 30342-1625
(404) 257-1482
(404) 257-1483
Mailing address
960 JOHNSON FERRY RD STE 335, ATLANTA, GA 30342-1625
(404) 257-1482
(404) 257-1483
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
40893
CO
207Y00000X
Otolaryngology Physician
Primary
87662
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74205579
—
CO
Enumeration date
09/30/2006
Last updated
01/12/2021
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