Provider Demographics
NPI:1033118880
Name:LEE, JAMES J (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 1213
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-1213
Mailing Address - Country:US
Mailing Address - Phone:912-466-5000
Mailing Address - Fax:912-466-5013
Practice Address - Street 1:15 GABLE COURT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-6738
Practice Address - Country:US
Practice Address - Phone:912-466-5400
Practice Address - Fax:912-267-4749
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081257207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532206OtherBLUE CROSS BLUE SHIELD
IL036081257Medicaid
ILK16104Medicare PIN
ILK16105Medicare PIN
ILP00259808Medicare PIN
IL04532206OtherBLUE CROSS BLUE SHIELD