=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598864258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLE ANN LEE D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 TOWNE LAKE HLS E SUITE 240
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30189-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-926-1737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 WALLNUT HALL CIR
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30189-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-926-1737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 002215
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------