Individual
ROBERT W LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
9 RUSSELL DR, SUITE 201, ELLIJAY, GA 30540-5573
(706) 698-9679
(706) 698-9678
Mailing address
9 RUSSELL DR, SUITE 201, ELLIJAY, GA 30540-5573
(706) 698-9679
(706) 698-9678
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIRO05113
GA
111NR0400X
Rehabilitation Chiropractor
CHIRO05113
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G700756
MEDICARE PTAN
GA
01
—
CHIRO05113
LICENSE
GA
Enumeration date
09/25/2006
Last updated
06/18/2018
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