Provider Demographics
NPI:1376004473
Name:LEE, PETER YONG JOON (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:YONG JOON
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 HOSPITAL NORTH DR STE 150
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8111
Mailing Address - Country:US
Mailing Address - Phone:470-732-6950
Mailing Address - Fax:770-739-0138
Practice Address - Street 1:1625 HOSPITAL NORTH DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8111
Practice Address - Country:US
Practice Address - Phone:770-732-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.421462084P0800X
390200000X
GA963462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program