1972121606 NPI number — INFANT AND EARLY CHILDHOOD MENTAL HEALTH OF GEORGIA

Table of content: DR. HUN HEE KIM L'AC (NPI 1285892083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972121606 NPI number — INFANT AND EARLY CHILDHOOD MENTAL HEALTH OF GEORGIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFANT AND EARLY CHILDHOOD MENTAL HEALTH OF GEORGIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972121606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 48366
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30604-8366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-438-2951
Provider Business Mailing Address Fax Number:
706-608-9044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 PLEASANT HILL CHURCH RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30680-4255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-438-2951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
TOPPLE
Authorized Official First Name:
TRASIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-438-2951

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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