Provider Demographics
NPI:1013744515
Name:LEE, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1102 E LAMAR ST STE 2
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3781
Mailing Address - Country:US
Mailing Address - Phone:229-514-1444
Mailing Address - Fax:229-514-1422
Practice Address - Street 1:1102 E LAMAR ST STE 2
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3781
Practice Address - Country:US
Practice Address - Phone:229-514-1444
Practice Address - Fax:229-514-1422
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035180363L00000X
GAGAA-NP002812363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics