Healthcare Provider Details

I. General information

NPI: 1205108156
Provider Name (Legal Business Name): LEE JOHN SKANDALAKIS, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW SUITE 4025
ATLANTA GA
30309-1796
US

IV. Provider business mailing address

PO BOX 116943
ATLANTA GA
30368-6943
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-3750
  • Fax: 678-904-1107
Mailing address:
  • Phone: 404-941-1210
  • Fax: 404-941-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number027443
License Number StateGA

VIII. Authorized Official

Name: DR. LEE SKANDALAKIS
Title or Position: OWNER
Credential: M.D.
Phone: 404-351-3750