Healthcare Provider Details

I. General information

NPI: 1962422071
Provider Name (Legal Business Name): LEE ALEXANDER BEATTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S MAIN ST
MOUNT HOLLY NC
28120-1620
US

IV. Provider business mailing address

PO BOX 601067
CHARLOTTE NC
28260-1067
US

V. Phone/Fax

Practice location:
  • Phone: 704-587-2400
  • Fax: 704-587-2401
Mailing address:
  • Phone: 704-587-2400
  • Fax: 704-587-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24346
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: