Provider Demographics
NPI:1295883544
Name:EDWARDS, LEE C (PHD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:C
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 SALEM CHURCH RD SW
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-5901
Mailing Address - Country:US
Mailing Address - Phone:478-452-4969
Mailing Address - Fax:478-452-0807
Practice Address - Street 1:700 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2672
Practice Address - Country:US
Practice Address - Phone:478-452-4969
Practice Address - Fax:478-452-0807
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000402103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBDMMMedicare ID - Type Unspecified