Healthcare Provider Details

I. General information

NPI: 1861594863
Provider Name (Legal Business Name): METROPOLITAN ORAL SURGERY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 PEACHTREE ST NE SUITE 1202
ATLANTA GA
30361-6202
US

IV. Provider business mailing address

1175 PEACHTREE ST NE SUITE 1202
ATLANTA GA
30361-6202
US

V. Phone/Fax

Practice location:
  • Phone: 404-874-1115
  • Fax: 404-874-0624
Mailing address:
  • Phone: 404-874-1115
  • Fax: 404-874-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOYCE T. LEE
Title or Position: OWNER
Credential: DDS, MD
Phone: 404-874-1115