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NPI Code Detail

MEDICARE: SPENCER LEE

MEDICARE: SPENCER LEE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LN0005XCritical Care Neonatal Nurse PractitionerRN250442GA

General Provider Information

NPI Number : 1154705978
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPENCER LEE
Provider Business Mailing Address
First Line : 1711 TULLIE CIR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2305
Country : US
Telephone Number : 404-785-5413
Fax Number : 404-785-6233
Provider Business Practice Location Address
First Line : 1711 TULLIE CIR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2305
Country : US
Telephone Number : 404-785-5413
Fax Number : 404-785-6233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2015
Last Update Date : 07/10/2015

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Directions to “ SPENCER LEE ” Practice Location

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