Provider Demographics
NPI:1831118751
Name:S LEE GUICE III, MD, PLLC
Entity Type:Organization
Organization Name:S LEE GUICE III, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DARMER
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:704-342-8324
Mailing Address - Street 1:1918 RANDOLPH RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1100
Mailing Address - Country:US
Mailing Address - Phone:704-342-8155
Mailing Address - Fax:704-330-8513
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-342-8155
Practice Address - Fax:704-330-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19851208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891256TMedicaid
NC2198387EMedicare ID - Type Unspecified
NC891256TMedicaid