Provider Demographics
NPI:1700023215
Name:LEE, JONG I (DC)
Entity Type:Individual
Prefix:
First Name:JONG
Middle Name:I
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:5430 JIMMY CARTER BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1506
Mailing Address - Country:US
Mailing Address - Phone:770-451-0400
Mailing Address - Fax:770-451-0403
Practice Address - Street 1:5430 JIMMY CARTER BLVD
Practice Address - Street 2:STE 200
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1506
Practice Address - Country:US
Practice Address - Phone:770-451-0400
Practice Address - Fax:770-451-0403
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2021-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GACHIR007810111N00000X
GAHADS000768237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No111N00000XChiropractic ProvidersChiropractor