Basic Information
| Provider Information | |||||||||
| NPI: | 1245219500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PADOVE | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | BRIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 980 JOHNSON FERRY RD | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043033320 | ||||||||
| FaxNumber: | 4043033464 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 JOHNSON FERRY RD | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043033320 | ||||||||
| FaxNumber: | 4043033464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 029748 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 000652253E | 05 | GA | MEDICAID | 060043786 | 01 | GA | MCR RR | OTHER | 578910 | 01 | BCBS | OTHER | 00652253B | 05 | GA | MEDICAID | 000652253D | 05 | GA | MEDICAID |