Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Soomi Park, PA-C

Individual provider Physician Assistant · NPI 1184358566

Soomi Park, PA-C is a Physician Assistant in Cumming, Georgia. Qualified in 2021, 5 years ago. Practices with Northside Cardiovascular Professional Services, LLC, a 142-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia and Ohio.

Years since qualifying
5
Licensed in
GA, OH
In the registry since
2022
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Phone: (770) 844-3295
Fax: (404) 250-7330
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3525 Olentangy River Rd Ste 4330, Columbus, OH 43214-3937 — (614) 255-6900

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 12815 (GA)
Physician Assistant Taxonomy 363A00000X · Licence 50.007530RX (OH)

Record details

NPI number1184358566
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 12, 2022
Last updated in NPPESJanuary 10, 2025
Certification dateJanuary 10, 2025
Mailing address1200 Northside Forsyth Dr, Cumming, GA 30041-7659

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Northside Cardiovascular Professional Services, Llc — 142 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Cumming