Provider Demographics
NPI:1033170238
Name:LEE OBSTETRICS & GYNECOLOGY, PC
Entity type:Organization
Organization Name:LEE OBSTETRICS & GYNECOLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-745-6447
Mailing Address - Street 1:2375 CHAMPIONS BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6471
Mailing Address - Country:US
Mailing Address - Phone:334-745-6447
Mailing Address - Fax:334-742-0713
Practice Address - Street 1:2375 CHAMPIONS BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6471
Practice Address - Country:US
Practice Address - Phone:334-745-6447
Practice Address - Fax:334-742-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528501030Medicaid