Provider Demographics
NPI:1659488443
Name:LEE, JOSEPH GLENN (RPA, RA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GLENN
Last Name:LEE
Suffix:
Gender:M
Credentials:RPA, RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CRESTWORTH CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5777
Mailing Address - Country:US
Mailing Address - Phone:404-545-2731
Mailing Address - Fax:
Practice Address - Street 1:122 CRESTWORTH CT
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5777
Practice Address - Country:US
Practice Address - Phone:404-545-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
Provider Identifiers
StateIdentifier IDID TypeIssuer
06GA1247OtherCBRPA
260372OtherARRT (R)(CV)