Provider Demographics
NPI:1205933975
Name:LEE, DARRYL J (DC)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OFFICE MANAGER
Mailing Address - Street 1:2175 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-7045
Mailing Address - Country:US
Mailing Address - Phone:478-741-8877
Mailing Address - Fax:478-742-9401
Practice Address - Street 1:2175 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-7045
Practice Address - Country:US
Practice Address - Phone:478-741-8877
Practice Address - Fax:478-742-9421
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO002308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBWCMedicare ID - Type Unspecified
GAU25707Medicare UPIN