Provider Demographics
NPI:1639844517
Name:LEE, SYLVESTER JEROME
Entity Type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:JEROME
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MARTIN LUTHER KING JR DR SW STE 103
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-1636
Mailing Address - Country:US
Mailing Address - Phone:404-696-8330
Mailing Address - Fax:
Practice Address - Street 1:2600 MARTIN LUTHER KING JR DR SW STE 103
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1636
Practice Address - Country:US
Practice Address - Phone:404-696-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist