Individual provider Active NPI

Jin Park, M.D.

  • Vascular & Interventional Radiology Physician
  • Atlanta, GA
National Provider Identifier
1649399338
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
060547 Issued in GA
Practice address
1000 Johnson Ferry Rd NE
Radiology Department
Atlanta, GA 30342-1606
Phone
(404) 851-6323
NPI assigned
Mar 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2005-01290 NC
Vascular & Interventional Radiology Physician 2085R0204X 060547 GA Primary
Diagnostic Radiology Physician 2085R0202X 060547 GA
Vascular & Interventional Radiology Physician 2085R0204X MD430802 PA

Addresses

Primary practice location

1000 Johnson Ferry Rd NE
Radiology Department
Atlanta, GA 30342-1606

Mailing address

5605 Glenridge Dr Ste 325
Atlanta, GA 30342-1365
Phone (678) 553-7783

Other practice location 1

743 Spring St NE
Gainesville, GA 30501-3715
Phone (770) 219-8420

Other identifiers 1

IdentifierTypeStateIssuer
456003412MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080730000193 GA Practitioner - Diagnostic Radiology 5092889741 Reassigns benefits to 2 organizations
I20251120003323 GA Practitioner - Interventional Radiology 5092889741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Radiology Associates LLCGroup PAC ID 4486555398, 381 clinicians
Gainesville Radiology Group PCGroup PAC ID 9335046382, 65 clinicians

Practice addresses (Care Compare)

1000 Johnson Ferry Rd
Atlanta, GA 30342-1606
Phone (404) 662-2438

1000 Johnson Ferry Rd NE
Atlanta, GA 30342-1606
Phone (404) 662-2438

11692 Parkside Ave
Alpharetta, GA 30005-2419
Phone (404) 662-2438

743 Spring Nest
Gainesville, GA 30501-3715
Phone (770) 219-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.75 of 100Reported as group
Quality
96.18
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
060547GAMDDiagnostic Radiology Physician
2005-01290NCMDDiagnostic Radiology Physician
MD430802PAMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Physicians Group Inc CurrentSince Oct 1, 2025 Accepting new patients
Gainesville Radiology Group, PC Diagnostic Radiology CurrentSince Apr 1, 2025 Accepting new patients
Northside Radiology Associates LLC Diagnostic Radiology CurrentSince Jul 1, 2008 Accepting new patients
Open MRI and CT Specialists of Stockbridge Diagnostic Radiology PastSince Mar 16, 2009 Accepting new patients
Northeast Georgia Medical Center, Inc. Past Accepting new patients

Locations

100 Galleria Pkwy SE
Ste 1450
Atlanta, GA 30339
Phone (770) 952-8899

1524 River Pl
Ste 100
Braselton, GA 30517
Phone (770) 532-7092

1400 River Pl
Braselton, GA 30517
Phone (770) 219-6000

227 Mountain Dr
Dahlonega, GA 30533
Phone (706) 864-6136

495 Highway 400
Dahlonega, GA 30533
Phone (469) 757-1107

108 Prominence Ct
Ste 120
Dawsonville, GA 30534
Phone (706) 344-6944

541 441 Historic Hwy N
Demorest, GA 30535
Phone (706) 839-4000

743 Spring St NE
Gainesville, GA 30501
Phone (770) 219-5915

597 S Enota Dr NE
Gainesville, GA 30501
Phone (770) 219-8275

725 Jesse Jewell Pkwy SE
Ste 360
Gainesville, GA 30501
Phone (770) 539-9391

3137 Frontage Rd
Gainesville, GA 30504
Phone (770) 219-0500

1250 Jesse Jewell Pkwy SE
Ste 500
Gainesville, GA 30501
Phone (770) 531-2444

11459 Johns Creek Pkwy
Ste 120
Johns Creek, GA 30097
Phone (678) 584-2210

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

5605 Glenridge Dr
Ste 325
Sandy Springs, GA 30342
Phone (678) 553-7783

316 N Broad St
Winder, GA 30680
Phone (770) 307-5354

316 N Broad St
Ste 230
Winder, GA 30680

Organizations & group practices 5

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1649399338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5605 GLENRIDGE DR STE 325",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421365",
            "telephone_number": "678-553-7783",
            "fax_number": "678-553-7793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD NE",
            "address_2": "RADIOLOGY DEPARTMENT",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421606",
            "telephone_number": "404-851-6323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "743 Spring St NE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013715",
            "country_code": "US",
            "telephone_number": "770-219-8420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2005-01290",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "GA",
            "license": "060547",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "060547",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "PA",
            "license": "MD430802",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "456003412",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.