Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 024014 | GA |
NPI | 1689606881 |
---|---|
Provider Name | Theodore Mark Lee |
First Address | Atlanta, GA 30309-2511 |
Second Address | Atlanta, GA 30309-2511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 06/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00278649H | (05) | GA |
00278649K | MEDICADE (01) | GA |
0481981 | AETNA (01) | |
1950 | COVENTRY (01) | |
2754388008 | CIGNA (01) | |
480827 | BCBS (01) | |
8791 | KAISER POS (01) | |
D40428 | (02) | |
P00162933 | RAILROAD MEDICARE (01) | GA |