Provider Demographics
NPI:1093770117
Name:LEE, FUSSELL, HUMPHREYS & HUMPHREYS, P.A.
Entity Type:Organization
Organization Name:LEE, FUSSELL, HUMPHREYS & HUMPHREYS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-355-2424
Mailing Address - Street 1:110 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5936
Mailing Address - Country:US
Mailing Address - Phone:252-355-2424
Mailing Address - Fax:252-355-2701
Practice Address - Street 1:110 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5936
Practice Address - Country:US
Practice Address - Phone:252-355-2424
Practice Address - Fax:252-355-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty