Individual provider Active NPI

Giwon Lee, P.T.

  • Physical Therapist
  • Dacula, GA
National Provider Identifier
1104212166
Registry record updated Nov 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT015154 Issued in GA
Practice address
2103 Braselton Hwy Suite 190B
Dacula, GA 30019
Phone
(470) 238-3407
NPI assigned
Apr 7, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT015154 GA Primary

Addresses

Primary practice location

2103 Braselton Hwy Suite 190B
Dacula, GA 30019

Mailing address

96 Candlewood LN
Hoschton, GA 30548-5554
Phone (503) 901-9772

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221025002925 GA Practitioner - Physical Therapist in Private Practice 4688900608 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kwon Physical Therapy LLCGroup PAC ID 0941688311, 6 clinicians

Practice addresses (Care Compare)

3473 Satellite Blvd
Suite 108N
Duluth, GA 30096-8690
Phone (470) 550-1271

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
G1L Physical Therapy P.C. CurrentSince Jul 24, 2022 Accepting new patients
Kwon Physical Therapy LLC Physical Therapist CurrentSince Oct 15, 2022 Accepting new patients
G1 Physical Therapy CurrentSince Nov 9, 2025 Accepting new patients
Fit in Motion TN LLC Physical Therapist Past Accepting new patients
Cornerstone Occupational Therapy PC Physical Therapist PastSince May 11, 2025 Accepting new patients

Locations

3473 Satellite Blvd
Ste 108N
Duluth, GA 30096
Phone (470) 550-1271

3420 Paddocks Pkwy
Suwanee, GA 30024
Phone (470) 295-6262

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762473600000",
    "number": "1104212166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 CANDLEWOOD LN",
            "city": "HOSCHTON",
            "state": "GA",
            "postal_code": "305485554",
            "telephone_number": "503-901-9772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 BRASELTON HWY SUITE 190B",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "30019",
            "telephone_number": "470-238-3407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "GIWON",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-07",
        "last_updated": "2025-11-07",
        "certification_date": "2025-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dacula, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.