Provider Demographics
NPI:1548697220
Name:AW BY CHUNG
Entity type:Organization
Organization Name:AW BY CHUNG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:
Authorized Official - First Name:HYERYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:770-875-9555
Mailing Address - Street 1:303 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-875-9555
Mailing Address - Fax:
Practice Address - Street 1:303 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5672
Practice Address - Country:US
Practice Address - Phone:770-875-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service