Basic Information
| Provider Information | |||||||||
| NPI: | 1679093595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 STANTONSBURG RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278342818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528474268 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 ACADEMY ST | ||||||||
| Address2: | |||||||||
| City: | AHOKSIE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522093000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2017 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | RTL | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2022-00866 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.