Individual
DR. JAE H PAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2160 FOUNTAIN DR, SUITE 200, SNELLVILLE, GA 30078-7022
(770) 982-1111
(770) 982-7280
Mailing address
2160 FOUNTAIN DR, SUITE 200, SNELLVILLE, GA 30078-7022
(770) 982-1111
(770) 982-7280
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
040185
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000678477E
—
GA
01
—
10594474
CAQH
GA
01
—
26BDJZQ
MEDICARE PTAN
GA
Enumeration date
07/22/2005
Last updated
06/03/2016
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