Provider Demographics
NPI:1790736650
Name:LEE, TIMOTHY S (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:LEE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 WALLACE RD STE C100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8018
Mailing Address - Country:US
Mailing Address - Phone:615-834-6166
Mailing Address - Fax:615-333-3118
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:SUITE C305
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-333-3115
Practice Address - Fax:615-333-3118
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA536872084N0400X
TN246672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511409OtherMEDICAID-MCC TEMP#
CA00A535870Medicaid
CAP00274932OtherRAILROAD MEDICARE
TNP00732471OtherRR MEDICARE
CAWA53587COtherPTAN PROVIDER IDENTIFIER
CAWA53587COtherPTAN PROVIDER IDENTIFIER
CAF58991Medicare UPIN