Provider Demographics
NPI:1134112766
Name:LEE, MARSHA V (MD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:V
Last Name:LEE
Suffix:
Gender:F
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:P.O. BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:901-226-3172
Mailing Address - Fax:901-226-3160
Practice Address - Street 1:8950 HWY 64
Practice Address - Street 2:SUITE 116
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002
Practice Address - Country:US
Practice Address - Phone:901-383-7170
Practice Address - Fax:901-388-6478
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4656078OtherAETNA
TN3171381OtherCIGNA
TN4052655OtherBCBS, TN
F94509Medicare UPIN
TN3171381OtherCIGNA
TN4052655OtherBCBS, TN