Provider Demographics
NPI:1518916998
Name:LEE, CHAE EUN (GNP)
Entity Type:Individual
Prefix:
First Name:CHAE
Middle Name:EUN
Last Name:LEE
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13003
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-0003
Mailing Address - Country:US
Mailing Address - Phone:770-938-1757
Mailing Address - Fax:770-938-1759
Practice Address - Street 1:1990 LAKESIDE PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5884
Practice Address - Country:US
Practice Address - Phone:770-938-1757
Practice Address - Fax:770-938-1759
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN062923363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN062923OtherNURSE LICENSE NUMBER