Basic Information
| Provider Information | |||||||||
| NPI: | 1659041481 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AGA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 PEACHTREE ST NE STE 1620 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048857701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 PEACHTREE ST NE STE 1620 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048857701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2021 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | SUH | ||||||||
| AuthorizedOfficialFirstName: | JUNG | ||||||||
| AuthorizedOfficialMiddleName: | WHUN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4048811094 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 293D00000X | Y | Laboratories | Physiological Laboratory |
No ID Information.