1235101791 NPI number — TERRI ANDREA EDWARDS-LEE M.D.

Table of content: TERRI ANDREA EDWARDS-LEE M.D. (NPI 1235101791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235101791 NPI number — TERRI ANDREA EDWARDS-LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS-LEE
Provider First Name:
TERRI
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235101791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
397 WALLACE RD
Provider Second Line Business Mailing Address:
STE C305
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37211-4854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-333-3115
Provider Business Mailing Address Fax Number:
615-333-3118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
397 WALLACE RD
Provider Second Line Business Practice Location Address:
STE C305
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211-4854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-333-3115
Provider Business Practice Location Address Fax Number:
615-333-3118
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  A53717 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00732475 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00A537170 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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