Jean Young Song, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

54344 Issued in GA

Practice address

555 Old Norcross Rd
Suite 210
Lawrenceville, GA 30045-8716

Phone

(770) 822-6360

Fax

(678) 442-7648

NPI assigned

Mar 7, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jsong24137@choa.gadirect.net

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.

• Gwinnett Physician Group, LLC

  • Internal Medicine Physician
  • Lawrenceville, GA
  • NPI 1578574661
  NPD (past)

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881725620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5795 RIVERWOOD DR NW",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303283726",
            "telephone_number": "404-255-4842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 OLD NORCROSS RD",
            "address_2": "SUITE 210",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300458716",
            "telephone_number": "770-822-6360",
            "fax_number": "678-442-7648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "JEAN",
        "middle_name": "YOUNG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "54344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "578964263A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Solvanta Health LLC
• Afsha Somani
• James Son, LCSW
• Aida Sonbati, RPH
• Hyunjin Song, MD
• Sarika Soni, M.S. CCC. SLP
• Christiana Oluwatoyin Sonuga, LCSW, ACM-SW
• Perla Johana Sorto, BA/PP
• Sherley Marissa Sosa, BCBA
• Katelyn Soska

• Pediatrics Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.