Provider Demographics
NPI:1073505830
Name:LEE, STANLEY M (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WHITE BRIDGE RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1499
Mailing Address - Country:US
Mailing Address - Phone:615-356-4111
Mailing Address - Fax:615-356-8011
Practice Address - Street 1:28 WHITE BRIDGE RD
Practice Address - Street 2:STE. 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1499
Practice Address - Country:US
Practice Address - Phone:615-356-4111
Practice Address - Fax:615-356-8011
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN19189207RN0300X
KY31677207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3036579Medicaid
KY64793303Medicaid
TN3036579Medicare PIN
KY64793303Medicaid
KYK033320Medicare PIN