Basic Information
| Provider Information | |||||||||
| NPI: | 1376538520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3155 NORTH POINT PARKWAY | ||||||||
| Address2: | BUILDING F SUITE 100 ATTN CREDENTIALING DEPT | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706459181 | ||||||||
| FaxNumber: | 7706458455 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 WINDY HILL RD SE | ||||||||
| Address2: | SUITE 218 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300678665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706459181 | ||||||||
| FaxNumber: | 7706458455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 043681 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000757666J | 05 | GA | MEDICAID | 000757666K | 05 | GA | MEDICAID | 000757666F | 05 | GA | MEDICAID | 000757666H | 05 | GA | MEDICAID | 000757666I | 05 | GA | MEDICAID | 000757666L | 05 | GA | MEDICAID | 000757666M | 05 | GA | MEDICAID | 000757666E | 05 | GA | MEDICAID | 000757666G | 05 | GA | MEDICAID |