1336390970 NPI number — DR. MELISSA A LEE MD

Table of content: DR. MELISSA A LEE MD (NPI 1336390970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336390970 NPI number — DR. MELISSA A LEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
MELISSA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLDNER
Provider Other First Name:
MELISSA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336390970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 748817
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-8817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-286-0333
Provider Business Mailing Address Fax Number:
813-282-1806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1116 LUCERNE TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-316-8550
Provider Business Practice Location Address Fax Number:
407-316-8311
Provider Enumeration Date:
10/01/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  ME0109090 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003826900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".