Provider Demographics
NPI:1003448044
Name:LEE, SEUNGHYUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEUNGHYUN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:142 RIVA RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6713
Mailing Address - Country:US
Mailing Address - Phone:912-481-2932
Mailing Address - Fax:
Practice Address - Street 1:4550 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2050
Practice Address - Country:US
Practice Address - Phone:770-969-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660261835P0018X
GARPH0315871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist