Provider Demographics
NPI:1053316521
Name:LEE, LOUIS G (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:7524 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31626-2754
Mailing Address - Country:US
Mailing Address - Phone:229-227-0045
Mailing Address - Fax:229-227-9120
Practice Address - Street 1:112 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6605
Practice Address - Country:US
Practice Address - Phone:229-227-0045
Practice Address - Fax:229-227-9120
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA021540174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000205994DMedicaid
GA000205994DMedicaid
GAD40430Medicare UPIN