MEDICARE: SIHWA LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP265302	GA
2	363L00000X	Nurse Practitioner	F08220260	GA

General Provider Information

NPI Number	:	1750090569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIHWA LEE

Provider Business Mailing Address
First Line	:	1283 HARVEST PARK LN
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-5616
Country	:	US
Telephone Number	:	770-815-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 RESURGENCE DR
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-7320
Country	:	US
Telephone Number	:	762-356-4785
Fax Number	:	762-728-6190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	10/07/2025

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Directions to “ SIHWA LEE ” Practice Location

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