Healthcare Provider Details

I. General information

NPI: 1710745666
Provider Name (Legal Business Name): LEE KORTO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 AUSTIN COMMON WAY
DACULA GA
30019-7777
US

IV. Provider business mailing address

2238 AUSTIN COMMON WAY
DACULA GA
30019-7777
US

V. Phone/Fax

Practice location:
  • Phone: 229-588-1995
  • Fax:
Mailing address:
  • Phone: 229-588-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN241923
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN241923
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: