Provider Demographics
NPI:1538578893
Name:LEE, LISA (MT(ASCP))
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MT(ASCP)
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT(ASCP)
Mailing Address - Street 1:102 JESSICA CT
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-3932
Mailing Address - Country:US
Mailing Address - Phone:478-396-5702
Mailing Address - Fax:
Practice Address - Street 1:102 JESSICA CT
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-3932
Practice Address - Country:US
Practice Address - Phone:478-396-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA167455247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician