Provider Demographics
NPI:1194923474
Name:LEE, GEORGE LEIGHTON III (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LEIGHTON
Last Name:LEE
Suffix:III
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:423 S SOUTH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-4577
Mailing Address - Country:US
Mailing Address - Phone:336-786-5144
Mailing Address - Fax:
Practice Address - Street 1:423 S SOUTH ST STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4577
Practice Address - Country:US
Practice Address - Phone:336-786-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53187-020208800000X
KY46918208800000X
VA0101267273208800000X
NC2021-02891208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2160632OtherDEA REGISTRATION NUMBER