MEDICARE: CARLO C LEE MD

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
1	207V00000X	Obstetrics & Gynecology Physician	041455	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1083619779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLO C LEE MD

Provider Business Mailing Address
First Line	:	PO BOX 2426
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31099-2426
Country	:	US
Telephone Number	:	478-923-6462
Fax Number	:	478-923-6215

Provider Business Practice Location Address
First Line	:	1570 WATSON BLVD
Second Line	:	SUITE 100
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3432
Country	:	US
Telephone Number	:	478-923-6462
Fax Number	:	478-923-6215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	08/08/2011

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Directions to “ CARLO C LEE MD” Practice Location

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