Provider Demographics
NPI:1427335629
Name:STEVEN R. LEE, M. D., P. C.
Entity type:Organization
Organization Name:STEVEN R. LEE, M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:770-452-0270
Mailing Address - Street 1:2150 PEACHFORD RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6520
Mailing Address - Country:US
Mailing Address - Phone:770-452-0270
Mailing Address - Fax:770-457-8517
Practice Address - Street 1:2150 PEACHFORD RD
Practice Address - Street 2:SUITE F
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6520
Practice Address - Country:US
Practice Address - Phone:770-452-0270
Practice Address - Fax:770-457-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0233782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000243878CMedicaid
GA255884281BMedicare PIN
D70534Medicare UPIN