Jiyo Shin (NPI# 1922282102, PAC ID# 5496944647) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1922282102 |
| PAC ID by PECOS | 5496944647 |
| Professional Enrollment ID | I20110104000980 |
| Full Name | Jiyo Shin |
| Organization Legal Name | WELLSTAR MEDICAL GROUP, LLC |
| Address |
4579 S Cobb S E Dr Suites 300 400 Smyrna GA 30080 |
| Phone Number | 7703332020 |
| Gender | F |
| Graduation Year | 2001 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 6709065402 |
| Number of Group Practice Members | 1320 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 110143 | WELLSTAR COBB HOSPITAL |
| 110035 | WELLSTAR KENNESTONE HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 5150 Stilesboro N W Rd, Suite 120, Kennesaw, GA 30152 | 6783540230 | WELLSTAR MEDICAL GROUP, LLC |
| 5150 Stilesboro N W Rd, Suite 220, Kennesaw, GA 30152-7742 | 7704248222 | WELLSTAR MEDICAL GROUP, LLC |
| 4441 Atlanta Rd Se, Smyrma, GA 30080-6537 | WELLSTAR MEDICAL GROUP, LLC | |
| 4579 S Cobb S E Dr, Suites 300 400, Smyrna, GA 30080 | 7703332020 | WELLSTAR MEDICAL GROUP, LLC |
| 4581 S Cobb S E Dr, Suite 100, Smyrna, GA 30080-6906 | 7708015000 | WELLSTAR MEDICAL GROUP, LLC |
| 4581 S Cobb Sedr, Suite 100, Smyrna, GA 30080-6906 | 7708015020 | WELLSTAR MEDICAL GROUP, LLC |
| Organization Legal Name | WELLSTAR MEDICAL GROUP, LLC |
| Physicians | 1338 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Phong Hoang Do | Family Medicine | Wellstar Medical Group, LLC | 5150 Stilesboro N W Rd, Suite 220, Kennesaw, GA 30152-7742 |
| Francheska Desravines Alcide | Family Medicine | Wellstar Medical Group, LLC | 687 Marietta Hwy, Canton, GA 30114-2608 |
| Marcus J Gates | Neurosurgery | Wellstar Medical Group, LLC | 625 Church Nest, Marietta, GA 30060-1101 |
| Nimota A Adeboye | Nurse Practitioner | Wellstar Medical Group, LLC | 3886 Princeton Lakes Way Sw, Atlanta, GA 30331-5511 |
| Vanessa Jill Lancaster | Nurse Practitioner | Wellstar Medical Group, LLC | 1360 Upper Hembree Rd, Roswell, GA 30076-1230 |
| Janna Williams-pitts | Psychologist, Clinical | Wellstar Medical Group, LLC | 3805 Cherokee Nwst, Kennesaw, GA 30144-2085 |
| Abhishek Kumar Singh | Family Medicine | Wellstar Medical Group, LLC | 121 Marble Mill N W Rd, Suite 101, Marietta, GA 30060-7959 |
| Khuram Ashraf | Internal Medicine | Wellstar Medical Group, LLC | 6043 Prestley Mill Rd C, Douglasville, GA 30134-2280 |
| Jonathan Noel Dodd | Psychologist, Clinical | Wellstar Medical Group, LLC | 3939 Roswell Rd, Marietta, GA 30062-6285 |
| Matthew Charles Agan | Neurology | Wellstar Medical Group, LLC | 780 Canton Rd Ne, Suite 400, Marietta, GA 30060-7298 |
| Street Address |
4579 S COBB S E DR SUITES 300 400 |
| City | SMYRNA |
| State | GA |
| Zip | 30080 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Janeen O Clark | Family Medicine | Wellstar Medical Group, LLC | 4579 S Cobb S E Dr, Suites 300 400, Smyrna, GA 30080 |
| Hima Edupuganti | Internal Medicine | Wellstar Medical Group, LLC | 4579 S Cobb S E Dr, Suites 300 400, Smyrna, GA 30080 |
| Rachel Gallen | Family Medicine | Wellstar Medical Group, LLC | 4579 S Cobb S E Dr, Suites 300 400, Smyrna, GA 30080 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Donna Leach | Audiologist | Family Hearing and Speech Center of West Cobb, Inc. | 2430 Atlanta Rd Se, Suite 100, Smyrna, GA 30080-1522 |
| Jean W. Bastia | Nurse Practitioner | 2220 Atlanta Rd Se, Suite 102, Smyrna, GA 30080-1541 | |
| Eric L Brown | Obstetrics/gynecology | 2635 S Cobb Sedr, Smyrna, GA 30080-1845 | |
| Nathan H Schwartz | Podiatry | 861 Windy Hill Rd Se, Smyrna, GA 30080-1903 | |
| Marc W Ugell | Chiropractic | 1995 Windy Hill Rd, Suite 7, Smyrna, GA 30080-2273 | |
| Lucas Drew Southerland | Chiropractic | Parkerson Chiropractic Clinic Inc | 2424 Herodian Way, Smyrna, GA 30080-2904 |
| Don N Parkerson Jr. | Chiropractic | Parkerson Chiropractic Clinic Inc | 2424 Herodian Way, Smyrna, GA 30080-2904 |
| Charles W Neal | Chiropractic | Parkerson Chiropractic Clinic Inc | 2424 Herodian Way, Smyrna, GA 30080-2904 |
| Jane M Kassens | Nurse Practitioner | Piedmont Professional Services, LLC | 2670 Cobb Pkwy Se, Smyrna, GA 30080-3014 |
| Iris D Amaker | Nurse Practitioner | Piedmont Professional Services, LLC | 2670 Cobb Pkwy Se, Smyrna, GA 30080-3014 |
| Find all physicians in zip 30080 | |||
| City | SMYRNA |
| Zip Code | 30080 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | SMYRNA + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Jiyo Shin.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.