Provider Demographics
NPI:1043303704
Name:SEOK, WOUN (DO)
Entity type:Individual
Prefix:
First Name:WOUN
Middle Name:
Last Name:SEOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DULUTH PARK LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3242
Mailing Address - Country:US
Mailing Address - Phone:678-417-0332
Mailing Address - Fax:
Practice Address - Street 1:3500 DULUTH PARK LN
Practice Address - Street 2:SUITE 220
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3242
Practice Address - Country:US
Practice Address - Phone:678-417-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA054279OtherLICENSE
GA1043303704Medicare NSC
GA5828920001Medicare NSC