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General NPI Number Information
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NPI Number | 1255310363
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Entity Type | Individual
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Provider Name | CHARLES IVY LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 4025 PEPPERWOOD CIR SW STE C
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City | HUNTSVILLE
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State | AL
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Zip | 35801-7438
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Country | US
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Telephone | 256-715-8193
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Fax | 256-715-8195
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Provider Business Mailing Address
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Address Line | 4025 PEPPERWOOD CIR SW STE C
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City | HUNTSVILLE
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State | AL
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Zip | 35801-7438
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Country | US
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Telephone | 256-715-8193
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Fax | 256-715-8195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | 14864
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 00014864
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 14864
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License Number State | AL
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