MEDICARE: DR. LEE JOHN SKANDALAKIS 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	208600000X	Surgery Physician	27443	GA
2	208600000X	Surgery Physician	027443	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518907625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE JOHN SKANDALAKIS M.D.

Provider Business Mailing Address
First Line	:	3193 HOWELL MILL RD NW STE 125
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2100
Country	:	US
Telephone Number	:	770-696-3586
Fax Number	:	877-795-8175

Provider Business Practice Location Address
First Line	:	3193 HOWELL MILL RD NW STE 125
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2100
Country	:	US
Telephone Number	:	770-696-3586
Fax Number	:	877-795-8175

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	12/13/2018

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