Provider Demographics
NPI:1891081436
Name:LEE, JAE IN (AP)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:IN
Last Name:LEE
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 STEVE REYNOLDS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8839
Mailing Address - Country:US
Mailing Address - Phone:770-623-0025
Mailing Address - Fax:
Practice Address - Street 1:3230 STEVE REYNOLDS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8839
Practice Address - Country:US
Practice Address - Phone:770-623-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA220171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist