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General NPI Number Information
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NPI Number | 1902748783
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Entity Type | Individual
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Provider Name | JAE WON LEE
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Gender | Male
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 417 W 3RD AVE
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City | ALBANY
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State | GA
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Zip | 31701-1943
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Country | US
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Telephone | 229-312-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 6216 BROOKRIDGE DR
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-5378
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Country | US
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Telephone | 678-617-6605
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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 | 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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