MEDICARE: DR. YONG S. LEE MD

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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	37597	GA
2	208VP0000X	Pain Medicine Physician	37597	GA
3	208100000X	Physical Medicine & Rehabilitation Physician	37597	GA

General Provider Information

NPI Number	:	1952304933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YONG S. LEE MD

Provider Business Mailing Address
First Line	:	900 CIRCLE 75 PKWY SE
Second Line	:	SUITE 1700
City	:	ATLANTA
State	:	GA
Zip	:	30339-3035
Country	:	US
Telephone Number	:	770-953-6929
Fax Number	:	770-953-6972

Provider Business Practice Location Address
First Line	:	148 BILL CARRUTH PKWY STE 120
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-3756
Country	:	US
Telephone Number	:	770-445-5666
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/10/2021

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