1760419196 NPI number — DAVID G LEE M.D.

Table of content: DAVID G LEE M.D. (NPI 1760419196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760419196 NPI number — DAVID G LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
DAVID
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1760419196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE VANTAGE WAY STE B240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37228-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-515-8160
Provider Business Mailing Address Fax Number:
615-327-4403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37236-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-284-8469
Provider Business Practice Location Address Fax Number:
615-284-3854
Provider Enumeration Date:
06/28/2006

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: 207P00000X , with the licence number:  9021 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4040147 . This is a "BLUECROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3167991 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3110213 . This is a "STONES RIVER IPA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 64747470 . This is a "KY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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