Provider Demographics
NPI:1902051592
Name:CHARLES LEE M.D.
Entity Type:Organization
Organization Name:CHARLES LEE M.D.
Other - Org Name:WHITESBURG PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-880-0222
Mailing Address - Street 1:1212 DEBORAH DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-1413
Mailing Address - Country:US
Mailing Address - Phone:256-990-7867
Mailing Address - Fax:
Practice Address - Street 1:115 QUEENSBURY DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1501
Practice Address - Country:US
Practice Address - Phone:256-880-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14864207Q00000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51523698OtherBCBS MADISON SURGICAL CENTER
AL51024029OtherBCBS HH LOCATIONS
AL51019925OtherBLUE CROSS OF ALABAMA
AL51024029OtherWHITESBURG PODIATRY LOCATION
AL51024029OtherBCBS HH LOCATIONS