Provider Demographics
NPI:1275227654
Name:LEE, ALEXANDER DOUGLAS (PA)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:DOUGLAS
Last Name:LEE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4014
Mailing Address - Country:US
Mailing Address - Phone:336-448-2427
Mailing Address - Fax:
Practice Address - Street 1:1901 S HAWTHORNE RD STE 310
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3915
Practice Address - Country:US
Practice Address - Phone:336-448-2427
Practice Address - Fax:336-765-2869
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13644363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-13644OtherNCMB LICENSE