Provider Demographics
NPI:1730989849
Name:LEE, YOHAYRA
Entity type:Individual
Prefix:
First Name:YOHAYRA
Middle Name:
Last Name:LEE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 OLD ALABAMA RD SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3201
Mailing Address - Country:US
Mailing Address - Phone:770-864-8486
Mailing Address - Fax:
Practice Address - Street 1:677 OLD ALABAMA RD SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3201
Practice Address - Country:US
Practice Address - Phone:770-864-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier