Provider Demographics
NPI:1114747193
Name:BYEON, JEONGA
Entity type:Individual
Prefix:
First Name:JEONGA
Middle Name:
Last Name:BYEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BATTLEFIELD CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5176
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:706-529-7210
Practice Address - Street 1:2358 LIFESTYLE WAY STE 212
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4904
Practice Address - Country:US
Practice Address - Phone:423-521-1100
Practice Address - Fax:423-521-1200
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily