Provider Demographics
NPI:1164848156
Name:LEE, JAMES R JR (BSN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:LEE
Suffix:JR
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 DILES BAY RD
Mailing Address - Street 2:
Mailing Address - City:TURBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29162-8892
Mailing Address - Country:US
Mailing Address - Phone:803-435-4355
Mailing Address - Fax:803-435-2065
Practice Address - Street 1:110 E BOYCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3408
Practice Address - Country:US
Practice Address - Phone:803-435-4355
Practice Address - Fax:803-435-2065
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60097163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health