Provider Demographics
NPI:1730385329
Name:LEE, ELLERMAN, AND ASSOCIATES, OD, PC
Entity type:Organization
Organization Name:LEE, ELLERMAN, AND ASSOCIATES, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:478-452-2611
Mailing Address - Street 1:223 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-1351
Mailing Address - Country:US
Mailing Address - Phone:706-343-1876
Mailing Address - Fax:
Practice Address - Street 1:223 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-1351
Practice Address - Country:US
Practice Address - Phone:706-343-1876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA002022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00113847OtherLEE RAILROADE MEDICARE ID
GA000743399KMedicaid
1679661250OtherNPI PERRY LEE
1730168485OtherNPI ELLERMAN
GADB6414OtherELLERMAN MEDICARE RAILROAD GROUP
GACK7619OtherLEE MEDICARE RAILROAD GROUP
GA465525028AMedicaid
GAP00119368OtherELLERMAN RAILROAD MEDICARE ID
GAP00119368OtherELLERMAN RAILROAD MEDICARE ID
GAP00113847OtherLEE RAILROADE MEDICARE ID
GA000743399KMedicaid
GA465525028AMedicaid