Provider Demographics
NPI:1235101791
Name:EDWARDS-LEE, TERRI ANDREA (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:ANDREA
Last Name:EDWARDS-LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 WALLACE RD
Mailing Address - Street 2:STE C305
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4854
Mailing Address - Country:US
Mailing Address - Phone:615-333-3115
Mailing Address - Fax:615-333-3118
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:STE C305
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-333-3115
Practice Address - Fax:615-333-3118
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA537172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00732475OtherRR MEDICARE
CA00A537170Medicaid
CAWA53717BMedicare ID - Type UnspecifiedPPIN
TN38276061Medicare PIN
CAG57737Medicare UPIN
CAWA53717CMedicare ID - Type UnspecifiedPPIN
CA00A537170Medicaid