Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 39152 | GA |
NPI | 1285703421 |
---|---|
Provider Name | Dr. Michael Lee |
First Address | Brentwood, TN 37027-7541 |
Second Address | Brentwood, TN 37027-7541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F26437 | (02) | GA |