Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 021540 | GA |
NPI | 1053316521 |
---|---|
Provider Name | Louis G Lee |
First Address | Boston, GA 31626-2754 |
Second Address | Thomasville, GA 31792-6605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 03/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000205994D | (05) | GA |
D40430 | (02) | GA |