Provider Demographics
NPI:1578634382
Name:LEE, CINDY F (NP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:F
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-3700
Mailing Address - Country:US
Mailing Address - Phone:229-723-6274
Mailing Address - Fax:
Practice Address - Street 1:103 RE JENNINGS AVE SE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:GA
Practice Address - Zip Code:39813-8725
Practice Address - Country:US
Practice Address - Phone:229-725-4251
Practice Address - Fax:229-725-2212
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN039505363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00803756AMedicaid
GA00803756AMedicaid
50BBCLZMedicare ID - Type Unspecified