Individual
CHONGMYONG DANIEL WON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
830 EAGLES LANDING PKWY STE 204, STOCKBRIDGE, GA 30281-7366
(770) 962-3642
(770) 962-3643
Mailing address
455 PHILIP BLVD STE 140, LAWRENCEVILLE, GA 30046-8768
(770) 962-3642
(770) 962-3643
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8489
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14192129
CAQH NUMBER
—
Enumeration date
07/17/2017
Last updated
10/20/2025
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