Provider Demographics
NPI:1336942994
Name:LEE, TIAH SHONTAYE (RN)
Entity type:Individual
Prefix:
First Name:TIAH
Middle Name:SHONTAYE
Last Name:LEE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3379 PEACHTREE RD NE STE 655
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1535
Mailing Address - Country:US
Mailing Address - Phone:404-956-6841
Mailing Address - Fax:
Practice Address - Street 1:1985 SAND DOLLAR CT SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8712
Practice Address - Country:US
Practice Address - Phone:757-218-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN290116251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion