Provider Demographics
NPI:1568441871
Name:WILKES, LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:WILKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4426 HUGH HOWELL RD
Mailing Address - Street 2:STE B303
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4918
Mailing Address - Country:US
Mailing Address - Phone:770-723-0817
Mailing Address - Fax:770-723-1691
Practice Address - Street 1:4500 HUGH HOWELL RD
Practice Address - Street 2:BUILDING 270, SUITE B
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4723
Practice Address - Country:US
Practice Address - Phone:770-723-0817
Practice Address - Fax:770-723-1691
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA41033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00676079HMedicaid
G24543Medicare UPIN
GA00676079HMedicaid