Provider Demographics
NPI:1558133025
Name:BLACKWELL, LEE BLACKWELL III (MABS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:BLACKWELL
Last Name:BLACKWELL
Suffix:III
Gender:M
Credentials:MABS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 FAIRWAYS CT STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7278
Mailing Address - Country:US
Mailing Address - Phone:770-389-1925
Mailing Address - Fax:770-389-3077
Practice Address - Street 1:831 FAIRWAYS CT STE A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7278
Practice Address - Country:US
Practice Address - Phone:770-389-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty