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NPI Code Detail

MEDICARE: LOUIS G LEE M.D.

MEDICARE: LOUIS G LEE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist021540GA
2207RG0100XGastroenterology Physician021540GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053316521
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOUIS G LEE M.D.
Provider Business Mailing Address
First Line : 7524 SUMMERHILL RD
Second Line :
City : BOSTON
State : GA
Zip : 31626-2754
Country : US
Telephone Number : 229-227-0045
Fax Number : 229-227-9120
Provider Business Practice Location Address
First Line : 112 MIMOSA DR
Second Line :
City : THOMASVILLE
State : GA
Zip : 31792-6605
Country : US
Telephone Number : 229-227-0045
Fax Number : 229-227-9120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 08/03/2020

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