Healthcare Provider Details

I. General information

NPI: 1659515609
Provider Name (Legal Business Name): DANA E LEE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ARMOUR DR NE 2109
ATLANTA GA
30324-3933
US

IV. Provider business mailing address

PO BOX 13612
ATLANTA GA
30324-0612
US

V. Phone/Fax

Practice location:
  • Phone: 770-241-9409
  • Fax:
Mailing address:
  • Phone: 770-241-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04170344
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN155009
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: