Provider Demographics
NPI:1679567275
Name:LEE, LAURANCE ISAAC (MD)
Entity type:Individual
Prefix:
First Name:LAURANCE
Middle Name:ISAAC
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7505 WATERS AVE
Mailing Address - Street 2:SUITE C8
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3825
Mailing Address - Country:US
Mailing Address - Phone:912-352-2606
Mailing Address - Fax:912-352-0623
Practice Address - Street 1:7505 WATERS AVE
Practice Address - Street 2:SUITE C8
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3825
Practice Address - Country:US
Practice Address - Phone:912-352-2606
Practice Address - Fax:912-352-0623
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0436842085R0204X, 2085U0001X, 2085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00335320OtherRR MCARE FOR SAVANNAH CHATHAM IMAGING
GAP00866844OtherRR MCARE FOR OUTPATIENT IMAGING SERVICES
GA00747887AMedicaid
GA650826OtherBLUE CROSS
SCG43684Medicaid
NY02493070Medicaid
NY02493070Medicaid
SCG43684Medicaid
GA202I309983-OIS METROMedicare PIN
GAP00866844OtherRR MCARE FOR OUTPATIENT IMAGING SERVICES
GA650826OtherBLUE CROSS
SCE664316289Medicare ID - Type UnspecifiedMEDICARE SC