Individual provider Active NPI

Jannet Hae Jung Shim, AGNP-C

  • Primary Care Nurse Practitioner
  • Tucker, GA
National Provider Identifier
1790547818
Registry record updated Sep 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
RN315429 Issued in GA
Practice address
1468 Montreal Rd
Tucker, GA 30084-6901
Phone
(770) 638-1400
NPI assigned
Jan 24, 2024
Last updated
Sep 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X RN315429 GA Primary
Adult Health Nurse Practitioner 363LA2200X RN315429 GA
Gerontology Nurse Practitioner 363LG0600X RN315429 GA

Addresses

Primary practice location

1468 Montreal Rd
Tucker, GA 30084-6901

Mailing address

1468 Montreal Rd
Tucker, GA 30084-6901
Phone (770) 638-1400

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240215001084 GA Practitioner - Nurse Practitioner 7517301781 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Truecare Medical LLC CurrentSince Jan 6, 2024 Accepting new patients

Locations

625 Beaver Ruin Rd NW
Ste E
Lilburn, GA 30047
Phone (678) 369-9399

302 Satellite Blvd NE
Ste 109
Suwanee, GA 30024
Phone (678) 731-7141

302 Satellite Blvd NE
Ste 109110
Suwanee, GA 30024
Phone (678) 369-9399

Interoperability endpoints

  • Direct secure messaging: jannet.shim.1@27557.direct.athenahealth.com

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789862400000",
    "number": "1790547818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1468 MONTREAL RD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300846901",
            "telephone_number": "770-638-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 MONTREAL RD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300846901",
            "telephone_number": "770-638-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIM",
        "first_name": "JANNET",
        "middle_name": "HAE JUNG",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-24",
        "last_updated": "2026-09-20",
        "certification_date": "2026-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN315429",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN315429",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "GA",
            "license": "RN315429",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

Verify at the official NPI Registry.