DR. JAE H PAK (NPI# 1740280551) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740280551 |
| Entity Type | Individual |
| Full Name | DR. JAE H PAK |
| Credential | M.D. |
| Practice Address |
2160 Fountain Dr Suite 200 Snellville GA 30078-7022 |
| Practice Telephone | 7709821111 |
| Practice Fax Number | 7709827280 |
| Mailing Telephone | 7709821111 |
| Mailing Fax Number | 7709827280 |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2016-06-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
040185 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | CAQH | 10594474 | 01 |
| GA | 000678477E | 05 | |
| GA | MEDICARE PTAN | 26BDJZQ | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215449483 | Jae B. Pak | Pharmacist | 3838 Bridgeport Way W, University Place, WA 98466-4416 | 2017-10-28 |
| 1275781163 | Jae Hyeong Pak | Dentist | 48 New Hyde Park Rd, Garden City, NY 11530-3909 | 2008-09-04 |
| 1780878991 | Jae Paul Pak | Emergency Medicine | 5757 Wilshire Blvd, Suite 2, Los Angeles, CA 90036-5810 | 2007-08-30 |
| Street Address |
2160 FOUNTAIN DR SUITE 200 |
| City | SNELLVILLE |
| State | GA |
| Zip Code | 30078-7022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326687930 | Joshua Morris | General Acute Care Hospital | 2160 Fountain Dr, Snellville, GA 30078-7022 | 2019-12-30 |
| 1457839219 | Melissa Marie Gray | Nurse Practitioner | 2160 Fountain Dr, Snellville, GA 30078-7022 | 2018-08-03 |
| 1114308475 | Kimberly Schiavoni | Nurse Practitioner | 2160 Fountain Dr, Suite D, Snellville, GA 30078-7022 | 2015-06-12 |
| 1578981130 | Eastside Behavioral Health Associates LLC | Psychiatry & Neurology | 2160 Fountain Dr, Suite 100, Snellville, GA 30078-7022 | 2014-04-01 |
| 1417192360 | Joshua Morris | Psychiatry & Neurology | 2160 Fountain Dr, Snellville, GA 30078-7022 | 2008-12-06 |
| 1235388935 | Robin Matney Boggess | Nurse Practitioner | 2160 Fountain Dr, Suite D, Snellville, GA 30078-7022 | 2008-09-17 |
| 1407069685 | Georgia Psychological Services for Seniors Inc | Clinical Neuropsychologist | 2160 Fountain Dr, Snellville, GA 30078-7022 | 2007-05-07 |
| 1396878500 | Franckel Val Md PC | Psychiatry & Neurology | 2160 Fountain Dr, Snellville, GA 30078-7022 | 2007-03-14 |
| 1134290497 | Frankel Val Md PC | Legal Medicine | 2160 Fountain Dr, Snellville, GA 30078-7022 | 2006-11-10 |
| 1457438541 | Heritage Medical Care LLC | Specialist | 2160 Fountain Dr, Snellville, GA 30078-7022 | 2006-11-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619594561 | Steven Nguyen | Optometrist | 1905 Scenic Hwy S #1130, Snellville, GA 30078 | 2020-06-26 |
| 1891320776 | Youstina Harkas | Optometrist | 1679 Scenic Hwy S 203, Snellville, GA 30078 | 2020-03-11 |
| 1578101127 | Jwwt Neuoromonitoring, LLC | Psychiatry & Neurology | 1350 Scenic Highway, Suite 266, Snelville, GA 30078 | 2019-12-13 |
| 1679119903 | Lashon Poole Wells | Social Worker | 1350 Scenic Highway Ste 266, 1350 Scenic Highway Ste 266, Snellville, GA 30078 | 2019-11-21 |
| 1427601426 | Aemad Heavenly Joy Senior Homecare & Developmental Disabilities LLC | Registered Nurse | 1350 Scenic Highway Suite #266, Sneville, GA 30078 | 2019-07-18 |
| 1063975548 | Joanne Mcdougal Patterson | Nurse Practitioner | 1350 Scenic Hwy N Ste 226, Snellville, GA 30078 | 2019-04-10 |
| 1689144263 | Israel Branford | Physical Therapist | 1575 Scenic Hwy Ste 100, Snellville, GA 30078 | 2018-11-27 |
| 1902382997 | Brittany Dupree | Dermatology | 2383 Pate Street North, Snellville, GA 30078 | 2018-07-13 |
| 1134610926 | Reid Weston Popple | Dentist | 2992 Stone Mountain Hwy, A100, Snellville, GA 30078 | 2018-05-29 |
| 1326550492 | Optimal Healthcare Services LLC | Clinic/Center | 2121 Fountain Dr Ste F, Snellville, GA 30078 | 2017-10-30 |
| Find all providers in zip 30078 | ||||
| Taxonomy Code | 2084P0805X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Geriatric Psychiatry |
| Geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184706996 | Jae Pak PC | Psychiatry & Neurology | 2160 Fountain Drive, 200, Snellville, GA 30078-6783 | 2006-10-20 |
| 1396878500 | Franckel Val Md PC | Psychiatry & Neurology | 2160 Fountain Dr, Snellville, GA 30078-7022 | 2007-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548513211 | Salveo Integrative Health | Psychiatry & Neurology | 301 Gwinnett Dr., Lawrenceville, GA 30046 | 2012-10-18 |
| 1821386855 | Outreach Psychiatric Associates, LLC | Psychiatry & Neurology | 250 Constitution Blvd, Ste 203, Lawrenceville, GA 30046-8432 | 2011-07-12 |
| 1336324144 | Leo O Noragbon | Psychiatry & Neurology | 728 Nightwind Way, Stockbridge, GA 30281-9134 | 2007-12-31 |
| 1457535155 | Michael S Conley M.d., P.C. | Psychiatry & Neurology | 285 Boulevard Ne Ste 315, Atlanta, GA 30312-4213 | 2007-12-18 |
| 1508087792 | Psychiatric Services of America | Psychiatry & Neurology | 311 Gwinnett Dr., Lawrenceville, GA 30046 | 2007-05-02 |
| 1194811174 | Adriana P Hermida | Psychiatry & Neurology | 826 Fieldstone Pkwy, Jonesboro, GA 30236-7500 | 2006-10-05 |
| 1689765844 | William Maffitt Mcdonald | Psychiatry & Neurology | Emory Division of Geriatric Psychiatry, Wesley Woods Health Center, 1841 Clifton Road Ne, Atlanta, GA 30329 | 2006-09-27 |
| 1760405211 | Frank Wayne Brown | Psychiatry & Neurology | 1899 E Gate Dr, Stone Mountain, GA 30087-1912 | 2006-07-25 |
| 1962858613 | Ruxandra Mares, Md | Psychiatry & Neurology | 100 Mariners Dr, Suite D, Kingsland, GA 31548-6666 | 2016-05-12 |
| 1356795462 | Tmc-behavioral Health of West Georgia | Psychiatry & Neurology | 101 Quartz Dr Ste 103, Villa Rica, GA 30180-3255 | 2016-04-15 |
| Find all providers with the same taxonomy | ||||
| City | SNELLVILLE |
| Zip Code | 30078 |
Please comment or provide details below to improve the information on DR. JAE H PAK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.