Healthcare Provider Details

I. General information

NPI: 1184240137
Provider Name (Legal Business Name): LEE Q TIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 PLAZA WAY NW
MARIETTA GA
30060-1104
US

IV. Provider business mailing address

72 PLAZA WAY NW
MARIETTA GA
30060-1104
US

V. Phone/Fax

Practice location:
  • Phone: 678-813-2741
  • Fax:
Mailing address:
  • Phone: 678-813-2741
  • Fax: 770-575-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number103611
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: