Provider Demographics
NPI:1174554455
Name:CHOI, BRICE (MD)
Entity type:Individual
Prefix:
First Name:BRICE
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9072
Mailing Address - Country:US
Mailing Address - Phone:770-507-7359
Mailing Address - Fax:
Practice Address - Street 1:1040 EAGLES LANDING PKWY
Practice Address - Street 2:102
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9072
Practice Address - Country:US
Practice Address - Phone:770-507-7359
Practice Address - Fax:770-389-3008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA044899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5722690001OtherMEDICARE DME
GA000783989FMedicaid
GAE48180Medicare UPIN