1295714574 NPI number — ARTHUR LEE MD

Table of content: ARTHUR LEE MD (NPI 1295714574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295714574 NPI number — ARTHUR LEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
ARTHUR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295714574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 PIEDMONT AVE
Provider Second Line Business Mailing Address:
STE. 700
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-756-5271
Provider Business Mailing Address Fax Number:
404-756-1402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 JESSE HILL JR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-4307
Provider Business Practice Location Address Fax Number:
404-616-1417
Provider Enumeration Date:
01/13/2006

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: 208600000X , with the licence number:  027077 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000293785C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: D45924 . This identifiers is of the category "MEDICARE UPIN".