Healthcare Provider Details

I. General information

NPI: 1659570455
Provider Name (Legal Business Name): KEVIN T. LIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 CUMBERLAND BLVD SE STE 520
ATLANTA GA
30339-6407
US

IV. Provider business mailing address

3225 CUMBERLAND BLVD SE STE 520
ATLANTA GA
30339-6407
US

V. Phone/Fax

Practice location:
  • Phone: 678-915-2000
  • Fax: 404-868-3363
Mailing address:
  • Phone: 678-915-2000
  • Fax: 404-868-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number35090995
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number35090995
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License Number35090995
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number35090995
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number35090995
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2085H0002X
TaxonomyHospice and Palliative Medicine (Radiology) Physician
License Number35090995
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number35090995
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number35090995
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number35090995
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35090995
License Number StateOH
# 11
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35090995
License Number StateOH
# 12
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number35090995
License Number StateOH
# 13
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35090995
License Number StateOH
# 14
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberGA81456
License Number StateGA
# 15
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number81456
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: