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Reo Jin Kim

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

10710 Medlock Bridge Rd Ste 200, Johns Creek, GA 30097-1998

PECOS Enrollment

This provider is enrolled in PECOS as REO KIM.

Based on the most recent information from CMS, provider Reo Jin Kim is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 9:24 AM.

Profile Details

Provider ID
1588339170
Provider Type
Individual
Full Name
Kim, Reo Jin
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
8/16/2021
Last Updated
8/16/2021

Contact Information

Practice Location

10710 Medlock Bridge Rd Ste 200, Johns Creek, GA 30097-1998

(770) 497-4188

Unlisted Fax

Mailing Location

10710 Medlock Bridge Rd Ste 200, Johns Creek, GA 30097-1998

(704) 974-1887

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License RN202224 Georgia

Reo Jin Kim

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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Hughson Chitolie, Charisse M

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Bhakta, Mayuri Ashok

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Nelson, Amanda Smith

Stage, Monique Jennifer