Provider Demographics
NPI:1790715621
Name:LEE, JAMES Y (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:310 GOLD CREEK TRAIL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188
Mailing Address - Country:US
Mailing Address - Phone:770-771-5600
Mailing Address - Fax:770-771-5609
Practice Address - Street 1:310 GOLD CREEK TRAIL
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188
Practice Address - Country:US
Practice Address - Phone:770-771-5600
Practice Address - Fax:770-771-5609
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08CBBFPMedicare PIN
H31301Medicare UPIN
H 31301Medicare UPIN