Provider Demographics
NPI:1548773690
Name:LEE, CAROLINE N (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:N
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:N
Other - Last Name:BAUKNECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 52226
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-0226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:691 14TH ST NW STE E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5625
Practice Address - Country:US
Practice Address - Phone:404-816-7900
Practice Address - Fax:404-816-7929
Is Sole Proprietor?:No
Enumeration Date:2017-11-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3451363A00000X
GA11385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant