Organization
MARK LEE NEUROSURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK R LEE M.D. (OWNER)
(706) 721-2624
Entity
Organization
Contact information
Practice address
1446 HARPER ST, BT5730, AUGUSTA, GA 30912-0012
(706) 721-2624
(706) 721-2652
Mailing address
PO BOX 2828, AUGUSTA, GA 30914-2828
(706) 868-0131
(706) 854-0131
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
039515
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPA945
—
SC
01
—
GRP8134
MEDICARE GROUP
GA
Enumeration date
05/24/2007
Last updated
10/18/2007
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