NPIMap

Individual provider Active NPI

Wanda Detiege-Lee, M.D.

  • Family Medicine Physician
  • Oneonta, AL
National Provider Identifier
1144334590
Registry record updated Feb 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14415 Issued in AL
Practice address
150 Gilbreath Dr
Oneonta Family Clinic
Oneonta, AL 35121-2827
Phone
(205) 274-3353
Fax
(205) 274-3354
NPI assigned
Aug 19, 2006
Last updated
Feb 18, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education Nutritionist 133NN1002X 14415 AL
Emergency Medicine Physician 207P00000X 00014415 AL
Family Medicine Physician 207Q00000X 14415 AL Primary
General Practice Physician 208D00000X 14415 AL
Hospice and Palliative Medicine (Emergency Medicine) Physician 207PH0002X 14415 AL

Addresses

Primary practice location

150 Gilbreath Dr
Oneonta Family Clinic
Oneonta, AL 35121-2827

Mailing address

150 Gilbreath Dr
Oneonta Family Clinic
Oneonta, AL 35121-2827
Phone (205) 274-3353

Other names 1

  • Wanda Lee Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
14415ALMDNutrition Education Nutritionist
00014415ALMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
BJC Medical Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Physicians Medical Staffing LLC Emergency Medicine Past Accepting new patients
North Georgia Emergency Physicians, LLC Emergency Medicine Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297987200000",
    "number": "1144334590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 GILBREATH DR",
            "address_2": "ONEONTA FAMILY CLINIC",
            "city": "ONEONTA",
            "state": "AL",
            "postal_code": "351212827",
            "telephone_number": "205-274-3353",
            "fax_number": "205-274-3354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 GILBREATH DR",
            "address_2": "ONEONTA FAMILY CLINIC",
            "city": "ONEONTA",
            "state": "AL",
            "postal_code": "351212827",
            "telephone_number": "205-274-3353",
            "fax_number": "205-274-3354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETIEGE-LEE",
        "first_name": "WANDA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2011-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "AL",
            "license": "14415",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "00014415",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "14415",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AL",
            "license": "14415",
            "primary": false
        },
        {
            "code": "207PH0002X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Hospice and Palliative Medicine",
            "state": "AL",
            "license": "14415",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WANDA",
            "last_name": "LEE",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Oneonta, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.