Provider Demographics
NPI:1659570455
Name:LIE, KEVIN T (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:T
Last Name:LIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3225 CUMBERLAND BLVD SE STE 520
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6407
Mailing Address - Country:US
Mailing Address - Phone:678-915-2000
Mailing Address - Fax:404-868-3363
Practice Address - Street 1:3225 CUMBERLAND BLVD SE STE 520
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6407
Practice Address - Country:US
Practice Address - Phone:678-915-2000
Practice Address - Fax:404-868-3363
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35090995207UN0901X, 207UN0902X, 207UN0903X, 2085B0100X, 2085D0003X, 2085H0002X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0001X, 2085R0202X, 2085R0203X, 2085R0204X
GAGA814562085R0204X
GA814562085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear Medicine
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085H0002XAllopathic & Osteopathic PhysiciansRadiologyHospice and Palliative Medicine
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH465114OtherWELLCARE
OH204881619259OtherCARESOURCE
GA003250880LMedicaid
PA1025726440001Medicaid
OHP00648554OtherRAILROAD MEDICARE
OH2788381Medicaid