Provider Demographics
NPI:1083912422
Name:LEE, MARTHA V
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:V
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4882 HADLEY FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828
Mailing Address - Country:US
Mailing Address - Phone:229-872-3539
Mailing Address - Fax:
Practice Address - Street 1:4882 HADLEY FERRY RD
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-7203
Practice Address - Country:US
Practice Address - Phone:229-872-3539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist