Provider Demographics
NPI:1851440127
Name:NA, SONG HUM (MD)
Entity type:Individual
Prefix:DR
First Name:SONG
Middle Name:HUM
Last Name:NA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4995 LANIER ISLANDS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1741
Mailing Address - Country:US
Mailing Address - Phone:678-546-5059
Mailing Address - Fax:678-546-5470
Practice Address - Street 1:4995 LANIER ISLANDS PKWY STE A
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1741
Practice Address - Country:US
Practice Address - Phone:678-546-5059
Practice Address - Fax:678-546-5470
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-12-26
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Provider Licenses
StateLicense IDTaxonomies
GA038059207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG05401Medicare UPIN