Individual
SOOMI PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1200 NORTHSIDE FORSYTH DR, CUMMING, GA 30041-7659
(770) 844-3295
(404) 250-7330
Mailing address
1200 NORTHSIDE FORSYTH DR, CUMMING, GA 30041-7659
(770) 844-3295
(404) 250-7330
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12815
GA
363A00000X
Physician Assistant
50.007530RX
OH
Other
Enumeration date
07/12/2022
Last updated
01/10/2025
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