Provider Demographics
NPI:1285622167
Name:LEE, JOHN W (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1800 WARM SPRINGS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8059
Mailing Address - Country:US
Mailing Address - Phone:706-324-5001
Mailing Address - Fax:706-596-8615
Practice Address - Street 1:1800 WARM SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8059
Practice Address - Country:US
Practice Address - Phone:706-324-5001
Practice Address - Fax:706-596-8615
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2010-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA030639207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000378837AMedicaid
GA000378837AMedicaid