Individual provider Active NPI

Song Un Lee, MD

  • Pediatrics Physician
  • Alpharetta, GA
National Provider Identifier
1902842693
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
46690 Issued in GA
Practice address
3795 Mansell Rd
Alpharetta, GA 30022-8247
Phone
(404) 785-8540
Fax
(404) 785-8574
NPI assigned
Jun 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 46690 GA Primary

Addresses

Primary practice location

3795 Mansell Rd
Alpharetta, GA 30022-8247

Mailing address

3795 Mansell Rd
Alpharetta, GA 30022-8247
Phone (404) 785-8540

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address choa@choa.gadirect.net

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160512000016 GA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 8123317385

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
46690GAMDPediatrics Physician

Interoperability endpoints

  • Direct secure messaging: slee4996@choa.gadirect.net

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1902842693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3795 MANSELL RD",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300228247",
            "telephone_number": "404-785-8540",
            "fax_number": "404-785-8574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3795 MANSELL RD",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300228247",
            "telephone_number": "404-785-8540",
            "fax_number": "404-785-8574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SONG",
        "middle_name": "UN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "46690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "choa@choa.gadirect.net",
            "affiliation": "N",
            "address_1": "3795 Mansell Rd",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300228247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

Verify at the official NPI Registry.