Organization
LEEWAY MEDICAL GROUP, P.C.
Active
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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