Provider Demographics
NPI:1043841364
Name:LEE, CRYSTAL H (LPN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-4156
Mailing Address - Country:US
Mailing Address - Phone:706-741-3235
Mailing Address - Fax:
Practice Address - Street 1:603 BROOKWOOD DR
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-4156
Practice Address - Country:US
Practice Address - Phone:706-741-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer