Individual
THEODORE MARK LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 PEACHTREE ST. NW, SUITE 720, ATLANTA, GA 30309-2511
(404) 351-7520
(404) 355-2048
Mailing address
1800 PEACHTREE ST. NW, SUITE 720, ATLANTA, GA 30309-2511
(404) 351-7520
(404) 355-2048
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
024014
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00278649H
—
GA
01
—
00278649K
MEDICADE
GA
01
—
0481981
AETNA
—
01
—
1950
COVENTRY
—
01
—
2754388008
CIGNA
—
01
—
480827
BCBS
—
01
—
8791
KAISER POS
—
01
—
P00162933
RAILROAD MEDICARE
GA
Enumeration date
07/07/2006
Last updated
04/06/2012
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