Individual
JIYOUN LEAH PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1468 MONTREAL RD, TUCKER, GA 30084-6901
(770) 638-1400
Mailing address
1468 MONTREAL RD, TUCKER, GA 30084-6901
(770) 638-1400
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
02/13/2015
Last updated
07/15/2015
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