Healthcare Provider Details

I. General information

NPI: 1669782926
Provider Name (Legal Business Name): LAM LE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 PLEASANT HILL RD STE C-4
DULUTH GA
30096-5899
US

IV. Provider business mailing address

1630 PLEASANT HILL RD STE C-4
DULUTH GA
30096-5899
US

V. Phone/Fax

Practice location:
  • Phone: 678-765-8476
  • Fax: 678-765-8479
Mailing address:
  • Phone: 678-765-8476
  • Fax: 678-765-8479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026949
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRPH026949
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: