Provider Demographics
NPI:1548478936
Name:LEE, JENNIFER J (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 COVEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6007
Mailing Address - Country:US
Mailing Address - Phone:615-835-3220
Mailing Address - Fax:
Practice Address - Street 1:155 COVEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6007
Practice Address - Country:US
Practice Address - Phone:615-835-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083436207N00000X
TNMD46202207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520909Medicaid
TN103I070376Medicare PIN