Individual
DR. JAE WOOK DONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4275 JOHNS CREEK PKWY STE A, SUWANEE, GA 30024
(678) 475-1606
(678) 475-1615
Mailing address
1355 PEACHTREE ST NE STE 1600, ATLANTA, GA 30309-3276
(678) 223-7774
(678) 223-7799
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
080202
GA
207R00000X
Internal Medicine Physician
125055845
IL
207R00000X
Internal Medicine Physician
40328
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003204609M
—
GA
Enumeration date
07/10/2009
Last updated
09/05/2018
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