Provider Demographics
NPI:1033007166
Name:LEE, DAKOTA MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:MICHELLE
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DAKOTA
Other - Middle Name:MICHELLE
Other - Last Name:AYCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:104 BRIDGETON DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-8513
Mailing Address - Country:US
Mailing Address - Phone:912-978-2060
Mailing Address - Fax:
Practice Address - Street 1:215 MIMS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-1994
Practice Address - Country:US
Practice Address - Phone:912-451-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN305792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse