MEDICARE: DR. SAMUEL LEE L.AC., O.M.D., PH.D.

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	171100000X	Acupuncturist	000012	GA

General Provider Information

NPI Number	:	1861603961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL LEE L.AC., O.M.D., PH.D.

Provider Business Mailing Address
First Line	:	1630 PLEASANT HILL RD
Second Line	:	#C-2
City	:	DULUTH
State	:	GA
Zip	:	30096-5899
Country	:	US
Telephone Number	:	678-380-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 PLEASANT HILL RD
Second Line	:	#C-2
City	:	DULUTH
State	:	GA
Zip	:	30096-5899
Country	:	US
Telephone Number	:	678-380-1100
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2011

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