Provider Demographics
NPI:1942207535
Name:COULTER, LEE A (PA-C)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:COULTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 JOHNSON FERRY RD NE
Mailing Address - Street 2:STE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1418
Mailing Address - Country:US
Mailing Address - Phone:404-257-9933
Mailing Address - Fax:404-257-9931
Practice Address - Street 1:875 JOHNSON FERRY RD NE
Practice Address - Street 2:STE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1418
Practice Address - Country:US
Practice Address - Phone:404-257-9933
Practice Address - Fax:404-257-9931
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCDFCMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GAP54432Medicare UPIN