Provider Demographics
NPI:1376007542
Name:LEE, EUN H
Entity type:Individual
Prefix:MRS
First Name:EUN
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 KINGLET CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5190
Mailing Address - Country:US
Mailing Address - Phone:404-512-1618
Mailing Address - Fax:
Practice Address - Street 1:3000 LANGFORD RD STE 300
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071-4772
Practice Address - Country:US
Practice Address - Phone:404-512-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAMBETTEROtherPEACHCARE