Provider Demographics
NPI:1326258054
Name:PETER K LEE MD PC
Entity Type:Organization
Organization Name:PETER K LEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-907-7222
Mailing Address - Street 1:34 UPPER RIVERDALE RD SE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2635
Mailing Address - Country:US
Mailing Address - Phone:770-907-7222
Mailing Address - Fax:770-991-3154
Practice Address - Street 1:34 UPPER RIVERDALE RD SE
Practice Address - Street 2:SUITE 100A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2635
Practice Address - Country:US
Practice Address - Phone:770-907-7222
Practice Address - Fax:770-991-3154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADD2539OtherRAILROAD MEDICARE
GAF91091Medicare UPIN
GAGRP7165Medicare PIN