Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS0000008427 | TN |
N | 204E00000X | Oral & Maxillofacial Surgeon | 40738 | TN |
NPI | 1588614804 |
---|---|
Provider Name | Dr. George S. Lee |
First Address | Clarksville, TN 37043-3097 |
Second Address | Clarksville, TN 37043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 20/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3227693 | (05) | TN |
I53447 | (02) | TN |