Provider Demographics
NPI:1033153671
Name:LEE, JOYCE T (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:T
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1202
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30361-6202
Mailing Address - Country:US
Mailing Address - Phone:404-874-1115
Mailing Address - Fax:404-874-0624
Practice Address - Street 1:1175 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1202
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30361-6202
Practice Address - Country:US
Practice Address - Phone:404-874-1115
Practice Address - Fax:404-874-0624
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0477931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H49568Medicare UPIN
85BBBDKMedicare ID - Type Unspecified