Individual
MRS. IRENE GUNG HO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C, MBA
Contact information
Practice address
3203 VINEVILLE AVE STE A, MACON, GA 31204
(478) 471-0273
(478) 471-1471
Mailing address
3203 VINEVILLE AVE STE A, MACON, GA 31204-2323
(478) 471-0273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2496
GA
363AM0700X
Medical Physician Assistant
Primary
006861
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003177670A
—
GA
05
—
003177670B
—
GA
05
—
003177670C
—
GA
Enumeration date
07/08/2013
Last updated
06/30/2018
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