Provider Demographics
NPI:1710745666
Name:KORTO, LEE (NP)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:KORTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 AUSTIN COMMON WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7777
Mailing Address - Country:US
Mailing Address - Phone:229-588-1995
Mailing Address - Fax:
Practice Address - Street 1:2238 AUSTIN COMMON WAY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7777
Practice Address - Country:US
Practice Address - Phone:229-588-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN241923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily