MEDICARE: CHARLES IVY LEE M.D.

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
1	207LA0401X	Addiction Medicine (Anesthesiology) Physician	14864	AL
2	207L00000X	Anesthesiology Physician	00014864	AL
3	208D00000X	General Practice Physician	14864	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51523698	OTHER	AL	BCBS MADISON SURG CTR
2	051019925	OTHER	AL	BCBS- AL INDIV
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	51024029	OTHER	AL	BCBS HH LOCATIONS

General Provider Information

NPI Number	:	1255310363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES IVY LEE M.D.

Provider Business Mailing Address
First Line	:	4025 PEPPERWOOD CIR SW STE C
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-7438
Country	:	US
Telephone Number	:	256-715-8193
Fax Number	:	256-715-8195

Provider Business Practice Location Address
First Line	:	4025 PEPPERWOOD CIR SW STE C
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-7438
Country	:	US
Telephone Number	:	256-715-8193
Fax Number	:	256-715-8195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	02/18/2026

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Directions to “ CHARLES IVY LEE M.D.” Practice Location

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