Provider Demographics
NPI:1922190537
Name:LEE, DOUGLAS O (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:O
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 JOHNS CREEK CT
Mailing Address - Street 2:STE 240
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3905 JOHNS CREEK CT
Practice Address - Street 2:STE 240
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1265
Practice Address - Country:US
Practice Address - Phone:770-630-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0401352084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF61389Medicare UPIN