Basic Information
| Provider Information | |||||||||
| NPI: | 1760419196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE VANTAGE WAY STE B240 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155158160 | ||||||||
| FaxNumber: | 6153274403 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372360001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152848469 | ||||||||
| FaxNumber: | 6152843854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 06/22/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 9021 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4040147 | 01 | TN | BLUECROSS | OTHER | 3167991 | 05 | TN | MEDICAID | 3110213 | 01 | TN | STONES RIVER IPA | OTHER | 64747470 | 01 | KY | KY MEDICAID | OTHER |