Johan Koo, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

77166 Issued in GA

Practice address

108 Prominence CT Ste 200
Dawsonville, GA 30534-6340

Phone

(706) 216-3238

Fax

(706) 216-5285

NPI assigned

Jun 21, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Lincoln Memorial University Medical Department, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peachtree Immediate Care FP, LLCGroup PAC ID 3274559323, 328 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156
  Medicare reassignment Care Compare group NPD
• Northeast Georgia Physicians Group Inc

  • Family Medicine Physician
  • Gainesville, GA
  • NPI 1891745212
  Medicare reassignment NPD
• Northeast Georgia Physicians Group Urgent Care LLC

  • Family Medicine Physician
  • Gainesville, GA
  • NPI 1790875037
  Medicare reassignment NPD
• Northside Urgent Care Holding, LLC

  • Urgent Care Clinic/Center
  • Atlanta, GA
  • NPI 1679962237
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1114280419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8420",
            "fax_number": "770-219-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 PROMINENCE CT STE 200",
            "city": "DAWSONVILLE",
            "state": "GA",
            "postal_code": "305346340",
            "telephone_number": "706-216-3238",
            "fax_number": "706-216-5285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "73 Maxwell Ln",
            "address_purpose": "LOCATION",
            "city": "Dahlonega",
            "state": "GA",
            "postal_code": "30533",
            "country_code": "US",
            "telephone_number": "770-219-9630",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376207430",
            "country_code": "US",
            "telephone_number": "423-844-5560",
            "fax_number": "423-844-5569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "777 Hemlock St",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312012102",
            "country_code": "US",
            "telephone_number": "478-633-7550",
            "fax_number": "478-633-3235",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "777 Hemlock St",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312012102",
            "country_code": "US",
            "telephone_number": "478-633-7550",
            "fax_number": "478-633-3235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOO",
        "first_name": "JOHAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-21",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "077166",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "77166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NFMUC_EastCobb@Northside.gwaydirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "73 Maxwell Ln",
            "city": "Dahlonega",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Suzanne Kimmons-Doty, OD
• Robert C King, LCSW
• Anna Katherine Kinley, MSN, APRN, CPNP
• Molly Magdalene Kirk
• Kelly Kolman, OTR/L
• Eric John Kron, D.P.M., F.A.C.F.A.S.
• Frank A Kruse III, DDS
• Victor Tsucci Kue, PHARMD
• Rebecca Lynn Kuehl, P.T, DPT
• Lawrence F Kulish, MD

• Family Medicine Physician in Dawsonville, GA
• Providers in Dawsonville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.