Provider Demographics
NPI:1275706541
Name:HOWARD, JERRY LEE II (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEE
Last Name:HOWARD
Suffix:II
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 1:1605 S LOCUST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4053
Mailing Address - Country:US
Mailing Address - Phone:931-762-6571
Mailing Address - Fax:
Practice Address - Street 1:1605 S LOCUST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4053
Practice Address - Country:US
Practice Address - Phone:931-762-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46459208600000X
PAMT187200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery