Provider Demographics
NPI:1659370682
Name:LEE, KUO L (MD)
Entity Type:Individual
Prefix:
First Name:KUO
Middle Name:L
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6734
Mailing Address - Country:US
Mailing Address - Phone:478-374-4305
Mailing Address - Fax:478-374-1366
Practice Address - Street 1:842 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6734
Practice Address - Country:US
Practice Address - Phone:478-374-4305
Practice Address - Fax:478-374-1366
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2010-05-20
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
GA014704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00184214AMedicaid
GAE59166Medicare UPIN