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General NPI Number Information
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NPI Number | 1245704600
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Entity Type | Individual
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Provider Name | SANG WOOK LEE MD
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Gender | Male
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1301 SIGMAN RD NE STE 180
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City | CONYERS
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State | GA
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Zip | 30012-3924
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Country | US
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Telephone | 770-922-4024
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 CHAUCER DR
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City | AUGUSTA
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State | GA
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Zip | 30909-6588
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 99842
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License Number State | GA
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