Basic Information
Provider Information
NPI: 1912952664
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ECONOMY
FirstName: LEE
MiddleName: N.
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1365 CLIFTON RD NE
Address2:  
City: ATLANTA
State: GA
PostalCode: 303221013
CountryCode: US
TelephoneNumber: 4047787402
FaxNumber: 4047784819
Practice Location
Address1: 1364 CLIFTON RD NE
Address2:  
City: ATLANTA
State: GA
PostalCode: 303221059
CountryCode: US
TelephoneNumber: 4047127100
FaxNumber: 4047784819
Other Information
ProviderEnumerationDate: 05/23/2006
LastUpdateDate: 04/13/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN156896GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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