Individual provider Active NPI

Youn Ju Lee, NP-C

  • Family Nurse Practitioner
  • Monroe, GA
National Provider Identifier
1396077756
Registry record updated Feb 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
153452 Issued in GA
Practice address
330 Alcovy St
Monroe, GA 30655-2140
Phone
(770) 267-1888
NPI assigned
Feb 9, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 153452 GA Primary

Addresses

Primary practice location

330 Alcovy St
Monroe, GA 30655-2140

Mailing address

1777 Westvale PL
Duluth, GA 30097-5267
Phone (404) 276-3993

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100315000247 GA Practitioner - Nurse Practitioner 1254466329 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
153452GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Acs Primary Care Physicians - Southeast PC CurrentSince Sep 1, 2011 Accepting new patients
Gwinnett Emergency Specialists Observation Services, LLC CurrentSince May 8, 2018 Accepting new patients

Locations

3620 Howell Ferry Rd
Duluth, GA 30096
Phone (678) 312-3294

101 Lake Oconee Pkwy
Eatonton, GA 31024
Phone (706) 485-0907

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

330 Alcovy St
Monroe, GA 30655
Phone (770) 267-1789

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

801 W Gordon St
Thomaston, GA 30286
Phone (706) 647-4371

Organizations & group practices 2

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": "1265673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265673600000",
    "number": "1396077756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 WESTVALE PL",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300975267",
            "telephone_number": "404-276-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 ALCOVY ST",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306552140",
            "telephone_number": "770-267-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "YOUN",
        "middle_name": "JU",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-09",
        "last_updated": "2010-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "153452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, GA

Sources for this page

Verify at the official NPI Registry.