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General NPI Number Information
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NPI Number | 1336942994
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Entity Type | Individual
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Provider Name | TIAH SHONTAYE LEE RN
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Gender | Female
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Dates
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Enumeration Date | 03/29/2025
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Last Update Date | 03/29/2025
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Provider Practice Location Address
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Address Line | 1985 SAND DOLLAR CT SW
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City | ATLANTA
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State | GA
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Zip | 30331-8712
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Country | US
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Telephone | 757-218-2810
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Fax |
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Provider Business Mailing Address
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Address Line | 3379 PEACHTREE RD NE STE 655
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City | ATLANTA
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State | GA
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Zip | 30326-1535
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Country | US
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Telephone | 404-956-6841
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Fax |
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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 | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | RN290116
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License Number State | GA
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