Individual
SUSAN C LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
28 JOHN DAVENPORT DR NW, ROME, GA 30165-2536
(706) 232-1503
(706) 235-3684
Mailing address
420 E 2ND AVE, SUITE 103, ROME, GA 30161-3209
(706) 509-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
40720
GA
207Q00000X
Family Medicine Physician
M7275
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003146455F
—
GA
05
—
8051076000
—
ID
Enumeration date
11/08/2006
Last updated
08/17/2015
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