Individual
JACOB LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
1260 HIGHWAY 54 STE 200, FAYETTEVILLE, GA 30214-4513
(770) 461-2101
Mailing address
2593 BROOKLINE CIR NE, BROOKHAVEN, GA 30319-3691
(404) 966-8576
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN122602
GA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
94785
GA
Other
Enumeration date
03/23/2017
Last updated
08/09/2023
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