Provider Demographics
NPI:1427006030
Name:WHEELER, LEE BURGESS (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:BURGESS
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MARATHON LN
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-0717
Mailing Address - Country:US
Mailing Address - Phone:706-970-0363
Mailing Address - Fax:
Practice Address - Street 1:162 MARATHON LN
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-0717
Practice Address - Country:US
Practice Address - Phone:706-970-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31529207P00000X, 207Q00000X
NC03381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E77991Medicare UPIN