Provider Demographics
NPI:1861695892
Name:LEE-LEWIS, COLETTE E (MD)
Entity type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:E
Last Name:LEE-LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 SHRINE RD
Mailing Address - Street 2:STE 270
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520
Mailing Address - Country:US
Mailing Address - Phone:912-262-2723
Mailing Address - Fax:877-244-5666
Practice Address - Street 1:3025 SHRINE RD
Practice Address - Street 2:STE 270
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520
Practice Address - Country:US
Practice Address - Phone:912-262-2723
Practice Address - Fax:877-244-5666
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055783207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA630423104AMedicaid
GA01035668OtherAMERIGROUP
GAP00215034OtherRILROAD MEDICARE
GA52043977OtherBLUE SHIELD
GAP00215034OtherRILROAD MEDICARE
GA01035668OtherAMERIGROUP
GA52043977OtherBLUE SHIELD