Provider Demographics
NPI:1538240072
Name:JEONG, SEONG-JOO (M D)
Entity type:Individual
Prefix:DR
First Name:SEONG-JOO
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 EVANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOOKOUT MTN
Mailing Address - State:TN
Mailing Address - Zip Code:37350-1445
Mailing Address - Country:US
Mailing Address - Phone:423-509-8917
Mailing Address - Fax:423-697-6100
Practice Address - Street 1:1009 EVANWOOD DR
Practice Address - Street 2:
Practice Address - City:LOOKOUT MTN
Practice Address - State:TN
Practice Address - Zip Code:37350-1445
Practice Address - Country:US
Practice Address - Phone:423-509-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00949207RC0200X, 207RP1001X
OH35.088657207RC0200X, 207RP1001X
TN46133207RC0200X, 207RP1001X
VA0101248183207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease