Provider Demographics
NPI:1881862431
Name:LEE, MAJA N (FNP)
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:N
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 MCDONOUGH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-1524
Mailing Address - Country:US
Mailing Address - Phone:770-775-7861
Mailing Address - Fax:
Practice Address - Street 1:1050 MCDONOUGH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1524
Practice Address - Country:US
Practice Address - Phone:770-775-7861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168506163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse