Healthcare Provider Details

I. General information

NPI: 1053436030
Provider Name (Legal Business Name): ANDREW LEE TAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HAZEL STREET
MACON GA
31201
US

IV. Provider business mailing address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 478-334-5050
  • Fax:
Mailing address:
  • Phone: 706-721-2371
  • Fax: 706-721-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN011613
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: