Provider Demographics
NPI:1760434617
Name:LEE, JOSEPHINE Y (ATC)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:Y
Last Name:LEE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2834 VININGS CENTRAL DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6785
Mailing Address - Country:US
Mailing Address - Phone:404-352-5865
Mailing Address - Fax:
Practice Address - Street 1:GEORGIA TECH ATHLETIC ASSOCIATION
Practice Address - Street 2:150 BOBBY DODD WAY, NW
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30332-0001
Practice Address - Country:US
Practice Address - Phone:404-385-2960
Practice Address - Fax:404-894-0695
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0006952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer