Basic Information
| Provider Information | |||||||||
| NPI: | 1720446644 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HAN | ||||||||
| FirstName: | MIJUNG | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1678 FLOWERY BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300112124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045181004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 755 WALTHER RD | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709620399 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2016 | ||||||||
| LastUpdateDate: | 02/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | RN204653 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.