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JACOB LEE DMD, MD
NPI 1912438805
Oral & Maxillofacial Surgery in Fayetteville, GA

Active since March 23, 2017PECOS Enrolled
1260 HIGHWAY 54 STE 200, FAYETTEVILLE, GA 30214(770) 461-2101 Get Directions Write a Review

NPPES record last updated: August 9, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 9, 2023, Mar 23, 2017 (2 updates tracked since 2017).

About Jacob Lee Dmd, Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACOB LEE DMD, MD (NPI 1912438805) is an individual oral & maxillofacial surgery provider in Fayetteville, Georgia, licensed in Georgia (94785) and active in the NPI registry since March 2017. He is enrolled in Medicare PECOS, maintains a secondary practice location in Newnan, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1912438805
Entity TypeIndividualMale
Primary Taxonomy204E00000X
Provider Legal NameJACOB LEECredential: DMD, MD
Location Address1260 HIGHWAY 54 STE 200Fayetteville, GA 30214-4513
Mailing Address2593 Brookline Cir NeBrookhaven, GA 30319-3691 · (404) 966-8576
Phone(770) 461-2101
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateMarch 23, 2017
Last NPPES UpdateAugust 9, 20232 updates tracked since enumeration
NPPES CertifiedAugust 9, 2023
✔ NPI 1912438805 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code204E00000X
License✔ Licensed in GA · 94785
Definition
Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.
Also ListedDentist · Oral and Maxillofacial SurgeryTaxonomy 1223S0112X · License DN122602 (GA)
1260 HIGHWAY 54 STE 200, Fayetteville, GA 30214
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Secondary Practice Location 1

Location 11825 Highway 34 E Ste 1700Newnan, GA 30265-6416 · Phone (470) 400-2637

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacob Lee Dmd, Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1557632197
PECOS Enrollment IDI20240805001927
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jacob Lee reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Atlanta Oral & Facial Surgery LLC
36 mi
Oral and Maxillofacial Surgery
1000 JOHNSON FERRY RD, BLDG H
Marietta, GA 30068
  • Reassigned Medicare billing, Georgia enrollment
  • 33 clinicians in this Medicare group
NPI 1992738165 (770) 977-0364

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Lee's NPI number?

The NPI number for Jacob Lee is 1912438805. It was assigned to this individual provider in the NPPES registry on March 23, 2017.

Where is Jacob Lee located?

Jacob Lee practices at 1260 Highway 54 Ste 200, Fayetteville, GA 30214. The listed phone number is (770) 461-2101.

What is Jacob Lee's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Is Jacob Lee enrolled in Medicare?

Yes. Jacob Lee is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jacob Lee's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Lee reassigns Medicare benefits to Atlanta Oral & Facial Surgery LLC (Marietta, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacob Lee's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jacob Lee accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Florida Combined Life and 5 other insurers list Jacob Lee as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jacob Lee was last updated on August 9, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.