Basic Information
| Provider Information | |||||||||
| NPI: | 1710306626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | ALEXANDRIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 W PEACHTREE ST NW APT 349 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303094772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047022736 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 UPPER RIVERDALE RD | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709918000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2014 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 80388 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.