Healthcare Provider Details

I. General information

NPI: 1205621349
Provider Name (Legal Business Name): MIA H LEE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
SANDY SPRINGS GA
30342-1606
US

IV. Provider business mailing address

1000 JOHNSON FERRY RD
SANDY SPRINGS GA
30342-1606
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8000
  • Fax: 404-851-6325
Mailing address:
  • Phone: 404-851-8000
  • Fax: 404-851-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP270734
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: