Jacob Lee, DMD, MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

94785 Issued in GA

Practice address

1260 Highway 54 Ste 200
Fayetteville, GA 30214-4513

Phone

(770) 461-2101

NPI assigned

Mar 23, 2017

Last updated

Aug 9, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial SurgeryAlso: Dentist

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Atlanta Oral and Facial Surgery LLCGroup PAC ID 8628062387, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Atlanta Oral & Facial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1992738165
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1490227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1912438805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2593 BROOKLINE CIR NE",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303193691",
            "telephone_number": "404-966-8576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 HIGHWAY 54 STE 200",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144513",
            "telephone_number": "770-461-2101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1825 Highway 34 E Ste 1700",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302656416",
            "country_code": "US",
            "telephone_number": "470-400-2637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "JACOB",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-23",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "GA",
            "license": "94785",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN122602",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Bruce Lebendiger, MD
• Angilee T Leconte, PMHNP-BC
• Rachel Lynn Lee Jackman, LPC
• Ashley T Lee, RD, LD
• Dave Childress Lee, D.M.D.
• Jennie Macleod Lee, OT
• Tesha Lee, RPH.
• Sonja Nicole Leflore, LPN
• Leger Therapy Services Inc. (CenterIMTAtlanta)
• Susan J. Leger, P.T.

• Oral & Maxillofacial Surgery (D.M.D.) in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.