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General NPI Number Information
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NPI Number | 1841997228
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Entity Type | Organization
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Legal Business Name | BLPODIATRY LLC
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 1325 SATELLITE BLVD NW STE 701A
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City | SUWANEE
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State | GA
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Zip | 30024-4676
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Country | US
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Telephone | 302-753-8294
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Fax |
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Provider Business Mailing Address
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Address Line | 4191 BAVERTON DR
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City | SUWANEE
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State | GA
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Zip | 30024-8725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / PODIATRIST
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Name | DR. BRIAN LEE
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Credential |
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Telephone | 770-765-1237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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