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General NPI Number Information
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NPI Number | 1376004473
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Entity Type | Individual
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Provider Name | PETER YONG JOON LEE MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 1625 HOSPITAL NORTH DRIVE SUITE 150
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City | AUSTELL
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State | GA
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Zip | 30106-8111
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Country | US
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Telephone | 770-732-6950
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 HOSPITAL NORTH DR STE 150
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City | AUSTELL
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State | GA
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Zip | 30106-8111
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Country | US
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Telephone | 470-732-6950
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Fax | 770-739-0138
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD.42146
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 96346
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License Number State | GA
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