Provider Demographics
NPI:1053305664
Name:MOCKRIN, LEE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:DAVID
Last Name:MOCKRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 25TH AVE N
Mailing Address - Street 2:STE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1515
Mailing Address - Country:US
Mailing Address - Phone:615-333-1440
Mailing Address - Fax:615-333-9639
Practice Address - Street 1:515 STONECREST PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6826
Practice Address - Country:US
Practice Address - Phone:615-223-1350
Practice Address - Fax:615-223-1351
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD35505208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3867471Medicaid
370019110OtherPALMETTO GBA
TN3867473Medicare PIN
TN3867471Medicaid