Provider Demographics
NPI:1881033207
Name:LEE, LATOYA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:JEAN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3371 BUFORD HWY NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1709
Mailing Address - Country:US
Mailing Address - Phone:404-836-0230
Mailing Address - Fax:305-698-6536
Practice Address - Street 1:1325 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1649
Practice Address - Country:US
Practice Address - Phone:404-836-0136
Practice Address - Fax:404-753-5266
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2019-10-07
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Provider Licenses
StateLicense IDTaxonomies
SCLL35942207Q00000X
GA76289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA76289OtherGA PROVIDER LICENSE- MD