MEDICARE: AIJELETH SHAHAR LEE

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	363A00000X	Physician Assistant	12681	GA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	12681	GA

General Provider Information

NPI Number	:	1417785643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIJELETH SHAHAR LEE

Provider Business Mailing Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-4622
Country	:	US
Telephone Number	:	404-712-2000
Fax Number	:

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

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	01/05/2026

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Directions to “ AIJELETH SHAHAR LEE ” Practice Location

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