Provider Demographics
NPI:1609761790
Name:LEE, EADON LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:EADON
Middle Name:LOUISE
Last Name:LEE
Suffix:
Gender:F
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 1:306 BUNCUM DR APT 4309
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2407
Mailing Address - Country:US
Mailing Address - Phone:803-607-7336
Mailing Address - Fax:
Practice Address - Street 1:306 BUNCUM DR APT 4309
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2407
Practice Address - Country:US
Practice Address - Phone:803-607-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant