MEDICARE: RACHEL MARCIA 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	174400000X	Specialist	6077	SC

General Provider Information

NPI Number	:	1801172176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARCIA LEE

Provider Business Mailing Address
First Line	:	169 DANZID DR
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-9281
Country	:	US
Telephone Number	:	843-871-9341
Fax Number	:

Provider Business Practice Location Address
First Line	:	7671 NORTHWOODS BLVD
Second Line	:	STE L
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4058
Country	:	US
Telephone Number	:	843-324-2956
Fax Number	:	843-871-9341

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

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	10/31/2011

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Directions to “ RACHEL MARCIA LEE ” Practice Location

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