NPIMap

Organization Active NPI

Jae Pak PC

  • Geriatric Psychiatry Physician
  • Snellville, GA
National Provider Identifier
1184706996
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
License
040185 Issued in GA
Legal business name
JAE PAK PC
Doing business as
Healthcare For Seniors
Practice address
2160 Fountain Drive
200
Snellville, GA 30078-6783
Phone
(770) 982-1111
Fax
(770) 982-7280
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Authorized official

Name
Jae H Pak, MDNPI 1740280551
Title
Owner Physician
Phone
(770) 982-1111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0805X 040185 GA Primary

Addresses

Primary practice location

2160 Fountain Drive
200
Snellville, GA 30078-6783

Mailing address

2160 Fountain Drive
200
Snellville, GA 30078-6783
Phone (770) 982-1111

Other names 1

  • Healthcare For Seniors Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050617000200 GA Part B Supplier - Clinic/Group Practice 5698719904 Receives reassigned benefits from 2 practitioners
Practice locations: Snellville, GA

National Provider Directory

National Provider Directory

Locations

2160 Fountain Dr
Ste 200
Snellville, GA 30078
Phone (770) 982-1111

2160 Fountain Dr
#B
Snellville, GA 30078
Phone (770) 982-1111

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1184706996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DRIVE",
            "address_2": "200",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300786783",
            "telephone_number": "770-982-1111",
            "fax_number": "770-982-7280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DRIVE",
            "address_2": "200",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300786783",
            "telephone_number": "770-982-1111",
            "fax_number": "770-982-7280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAE PAK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "PAK",
        "authorized_official_first_name": "JAE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "770-982-1111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "GA",
            "license": "040185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthcare For Seniors",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.