Provider Demographics
NPI:1285677872
Name:LEE, PAMELA C (APRN, BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 VAN STREAT HWY
Mailing Address - Street 2:
Mailing Address - City:NICHOLLS
Mailing Address - State:GA
Mailing Address - Zip Code:31554-5025
Mailing Address - Country:US
Mailing Address - Phone:912-345-2474
Mailing Address - Fax:912-345-2473
Practice Address - Street 1:1205 VAN STREAT HWY
Practice Address - Street 2:
Practice Address - City:NICHOLLS
Practice Address - State:GA
Practice Address - Zip Code:31554-5025
Practice Address - Country:US
Practice Address - Phone:912-345-2474
Practice Address - Fax:912-345-2473
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00441691CMedicaid
GA08BDJJXMedicare ID - Type Unspecified