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Organization

LEEWAY MEDICAL GROUP, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARVIN LEE III MD M.D. (PRESIDENT)
(770) 577-6121
Entity
Organization

Contact information

Practice address
8311 OFFICE PARK DR, DOUGLASVILLE, GA 30134-6935
(770) 577-6121
(770) 577-1152
Mailing address
1665 WATERWAY XING SW, ATLANTA, GA 30331-8060
(770) 577-6121
(770) 577-1152

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0400158
EVERCARE
GA
01
52255410 001
BCBS
GA
01
CH8739
MCRR
GA
Enumeration date
09/29/2006
Last updated
11/20/2007
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