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General NPI Number Information
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NPI Number | 1790013613
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Entity Type | Organization
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Legal Business Name | MARION O. LEE,JR. M.D., P.C.
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 910 N 5TH ST SUITE D
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City | CORDELE
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State | GA
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Zip | 31015-3254
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Country | US
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Telephone | 229-391-2910
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Fax | 229-386-4770
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Provider Business Mailing Address
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Address Line | 2773 MARSHALL DR
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City | TIFTON
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State | GA
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Zip | 31793-8101
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Country | US
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Telephone | 229-238-0121
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Fax | 229-238-0124
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MRS. NAKIA MCCOGGLE
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Credential |
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Telephone | 229-238-0298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 37596
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License Number State | GA
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