Provider Demographics
NPI:1447382221
Name:LEE, SUE ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name: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 1:6011 TROTWOOD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-7009
Mailing Address - Country:US
Mailing Address - Phone:931-388-9663
Mailing Address - Fax:931-388-7411
Practice Address - Street 1:6011 TROTWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-7009
Practice Address - Country:US
Practice Address - Phone:931-388-9663
Practice Address - Fax:931-388-7411
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14305207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB04765Medicare UPIN
TN3197756Medicare ID - Type Unspecified