MEDICARE: ELIZABETH H 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	1041C0700X	Clinical Social Worker	CSW001079	GA

General Provider Information

NPI Number	:	1871056424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH H LEE

Provider Business Mailing Address
First Line	:	236 E LAKE DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-3352
Country	:	US
Telephone Number	:	678-709-4359
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 E LAKE DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-3352
Country	:	US
Telephone Number	:	678-709-4359
Fax Number	:

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

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	04/10/2019

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