Provider Demographics
NPI:1629469069
Name:LEE, JULIE POTOMSKI (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:POTOMSKI
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MEDICAL PARK DR E STE 220
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3428
Mailing Address - Country:US
Mailing Address - Phone:205-838-4747
Mailing Address - Fax:205-838-2712
Practice Address - Street 1:52 MEDICAL PARK DR E STE 220
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3428
Practice Address - Country:US
Practice Address - Phone:205-838-4747
Practice Address - Fax:205-838-2712
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALTA.1790363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical