Healthcare Provider Details

I. General information

NPI: 1326699828
Provider Name (Legal Business Name): SUWANEE ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 HIGHLAND STATION DR STE 1008
SUWANEE GA
30024-6572
US

IV. Provider business mailing address

530 HIGHLAND STATION DR STE 1008
SUWANEE GA
30024-6572
US

V. Phone/Fax

Practice location:
  • Phone: 770-681-8888
  • Fax:
Mailing address:
  • Phone: 770-681-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDON YONGJO LEE
Title or Position: OWNER
Credential: L.AC.
Phone: 770-681-8888