Provider Demographics
NPI:1588614804
Name:LEE, GEORGE S (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 RUDOLPHTOWN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2226
Mailing Address - Country:US
Mailing Address - Phone:931-552-3292
Mailing Address - Fax:931-552-3243
Practice Address - Street 1:2285 RUDOLPHTOWN ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-552-3292
Practice Address - Fax:931-552-3243
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40738204E00000X, 2082S0099X
TNDS00000084271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3227693Medicaid
TNI53447Medicare UPIN
TN3227693Medicaid