Provider Demographics
NPI:1245219500
Name:PADOVE, LEE BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:BRIAN
Last Name:PADOVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:980 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:404-303-3320
Mailing Address - Fax:404-303-3464
Practice Address - Street 1:980 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 520
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-303-3320
Practice Address - Fax:404-303-3464
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029748207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000652253EMedicaid
GA060043786OtherMCR RR
578910OtherBCBS
GA00652253BMedicaid
GA000652253DMedicaid
F71099Medicare UPIN
GA000652253EMedicaid
GA06BDFHVMedicare PIN