Provider Demographics
NPI:1912330598
Name:LEE, CARMEN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ELIZABETH
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1900 10TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3602
Mailing Address - Country:US
Mailing Address - Phone:706-984-7400
Mailing Address - Fax:706-984-7401
Practice Address - Street 1:1900 10TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3602
Practice Address - Country:US
Practice Address - Phone:706-984-7400
Practice Address - Fax:706-984-7401
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97042208600000X
GA009137208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery