Healthcare Provider Details

I. General information

NPI: 1497629570
Provider Name (Legal Business Name): GEORGIA EPILEPSY & NEUROLOGY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 JOHNS CREEK PKWY STE C
SUWANEE GA
30024-9117
US

IV. Provider business mailing address

4275 JOHNS CREEK PKWY STE C
SUWANEE GA
30024-9117
US

V. Phone/Fax

Practice location:
  • Phone: 912-513-1041
  • Fax: 762-316-2051
Mailing address:
  • Phone: 912-513-1041
  • Fax: 762-316-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: KI HYEONG LEE
Title or Position: MANAGING DOCTOR
Credential: MD
Phone: 513-250-5703