Provider Demographics
NPI:1669130142
Name:KIM, SUE LEE (CNP)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:LEE
Last Name:KIM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 PLEASANT HILL RD STE 480
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8030
Mailing Address - Country:US
Mailing Address - Phone:770-623-6433
Mailing Address - Fax:770-623-6416
Practice Address - Street 1:3855 PLEASANT HILL RD STE 480
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8030
Practice Address - Country:US
Practice Address - Phone:770-623-6433
Practice Address - Fax:770-623-6416
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN208852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily