Provider Demographics
NPI:1831602242
Name:JOHN LEE MD, LLC
Entity type:Organization
Organization Name:JOHN LEE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-957-8908
Mailing Address - Street 1:4310 JOHNS CREEK PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6090
Mailing Address - Country:US
Mailing Address - Phone:678-957-8908
Mailing Address - Fax:678-854-8008
Practice Address - Street 1:4310 JOHNS CREEK PKWY STE 180
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6090
Practice Address - Country:US
Practice Address - Phone:678-957-8908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2022-11-01
Deactivation Date:2022-09-05
Deactivation Code:
Reactivation Date:2022-11-01
Provider Licenses
StateLicense IDTaxonomies
GA74026207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty