Provider Demographics
NPI:1376034983
Name:MCNICHOLS, LEE PENNINGTON (NP)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:PENNINGTON
Last Name:MCNICHOLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:PENNINGTON
Other - Last Name:STATEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:12460 CRABAPPLE RD.,
Mailing Address - Street 2:SUITE 202-313
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6646
Mailing Address - Country:US
Mailing Address - Phone:770-727-1167
Mailing Address - Fax:404-393-7788
Practice Address - Street 1:12460 CRABAPPLE RD.
Practice Address - Street 2:SUITE 202- 313
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6646
Practice Address - Country:US
Practice Address - Phone:770-727-1167
Practice Address - Fax:404-819-7660
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129155207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine