Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2011-00685 | NC |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2011-00685 | NC |
NPI | 1285808741 |
---|---|
Provider Name | Dr. Justin Allen Lee |
First Address | Charlotte, NC 28275-1069 |
Second Address | Durham, NC 27707-6226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 01/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
172M6 | BCBS (01) | NC |
5920939 | (05) | NC |
NC76260280 | (02) | NC |