Provider Demographics
NPI:1972699288
Name:LEE, GEORGE EARL
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:EARL
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-2664
Mailing Address - Country:US
Mailing Address - Phone:229-686-3087
Mailing Address - Fax:
Practice Address - Street 1:407 E MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2274
Practice Address - Country:US
Practice Address - Phone:229-686-9333
Practice Address - Fax:229-686-7888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00387494AMedicaid
GA00387494AMedicaid