Healthcare Provider Details

I. General information

NPI: 1053409797
Provider Name (Legal Business Name): LOUIS LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 DEKALB MEDICAL PKWY
LITHONIA GA
30058-4996
US

IV. Provider business mailing address

PO BOX 403631
ATLANTA GA
30384-3631
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-8492
  • Fax: 404-501-8645
Mailing address:
  • Phone: 770-740-0895
  • Fax: 770-740-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38840
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number038840
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: