Provider Demographics
NPI:1780623785
Name:LEE, JESSIE (MD)
Entity type:Individual
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First Name:JESSIE
Middle Name:
Last Name:LEE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:175 WHITE ST NW
Mailing Address - Street 2:SUITE 370
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1053
Mailing Address - Country:US
Mailing Address - Phone:678-741-2145
Mailing Address - Fax:770-919-2844
Practice Address - Street 1:175 WHITE ST NW
Practice Address - Street 2:SUITE 370
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1053
Practice Address - Country:US
Practice Address - Phone:678-741-2145
Practice Address - Fax:770-919-2844
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA46782207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology