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General NPI Number Information
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NPI Number | 1780623785
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Entity Type | Individual
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Provider Name | JESSIE LEE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 175 WHITE ST NW SUITE 370
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City | MARIETTA
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State | GA
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Zip | 30060-1053
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Country | US
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Telephone | 678-741-2145
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Fax | 770-919-2844
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Provider Business Mailing Address
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Address Line | 175 WHITE ST NW SUITE 370
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City | MARIETTA
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State | GA
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Zip | 30060-1053
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Country | US
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Telephone | 678-741-2145
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Fax | 770-919-2844
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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 | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 46782
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License Number State | GA
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