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General NPI Number Information
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NPI Number | 1609925205
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Entity Type | Individual
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Provider Name | CHANTEL MARIA LEE P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 2221 PEACHTREE ST. NE SUITE 471D
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City | ATLANTA
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State | GA
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Zip | 30309
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Country | US
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Telephone | 770-865-9023
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 PEACHTREE ST NW SUITE 700
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City | ATLANTA
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State | GA
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Zip | 30309-2519
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Country | US
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Telephone | 404-350-7966
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 005514
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 005514
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 005514
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License Number State | GA
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