Provider Demographics
NPI:1205515954
Name:LE, ELIZABETH KIM (RDMS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KIM
Last Name:LE
Suffix:
Gender:F
Credentials:RDMS
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Mailing Address - Street 1:6035 PEACHTREE RD STE C218
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30360-3240
Mailing Address - Country:US
Mailing Address - Phone:678-833-2433
Mailing Address - Fax:678-607-9301
Practice Address - Street 1:6035 PEACHTREE RD STE C218
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30360-3240
Practice Address - Country:US
Practice Address - Phone:678-833-2433
Practice Address - Fax:678-607-9301
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2024-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA1697382085U0001X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No293D00000XLaboratoriesPhysiological Laboratory