Provider Demographics
NPI:1457702862
Name:LEE, SOO JIN (DO)
Entity Type:Individual
Prefix:DR
First Name:SOO JIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 HIGHWAY 124
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4614
Mailing Address - Country:US
Mailing Address - Phone:770-978-1331
Mailing Address - Fax:770-978-8580
Practice Address - Street 1:3020 HWY 124
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039
Practice Address - Country:US
Practice Address - Phone:770-978-1331
Practice Address - Fax:770-978-8580
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL39374207Q00000X
GA83342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine