Healthcare Provider Details

I. General information

NPI: 1225994460
Provider Name (Legal Business Name): GRACE CARYN PRINCE LEE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 PEACHTREE ST
JESUP GA
31545-0246
US

IV. Provider business mailing address

330 PEACHTREE ST
JESUP GA
31545-0246
US

V. Phone/Fax

Practice location:
  • Phone: 912-415-8552
  • Fax: 888-440-6945
Mailing address:
  • Phone: 912-415-8552
  • Fax: 888-440-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN321617
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: