Provider Demographics
NPI:1790013613
Name:MARION O. LEE,JR. M.D., P.C.
Entity Type:Organization
Organization Name:MARION O. LEE,JR. M.D., P.C.
Other - Org Name:MARION O. LEE JR. M.D. PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOGGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-238-0298
Mailing Address - Street 1:2773 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8101
Mailing Address - Country:US
Mailing Address - Phone:229-238-0121
Mailing Address - Fax:229-238-0124
Practice Address - Street 1:910 N 5TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3254
Practice Address - Country:US
Practice Address - Phone:229-391-2910
Practice Address - Fax:229-386-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37596208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty