Provider Demographics
NPI:1174522023
Name:ANISMAN, LEE ROBERT (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ROBERT
Last Name:ANISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 15TH ST NE
Mailing Address - Street 2:UNIT 1221
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3535
Mailing Address - Country:US
Mailing Address - Phone:404-892-7960
Mailing Address - Fax:404-355-6370
Practice Address - Street 1:3280 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 326
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4111
Practice Address - Country:US
Practice Address - Phone:404-355-3788
Practice Address - Fax:404-355-6370
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA037939OtherMEDICAL LICENSE
GA190111023BMedicaid
GA190111023BMedicaid
11BDHJVMedicare ID - Type Unspecified
GA190111023BMedicaid