Provider Demographics
NPI:1730118225
Name:LEE, MARK ANDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDY
Last Name:LEE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:95 SEABOARD LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3031
Mailing Address - Country:US
Mailing Address - Phone:615-261-1214
Mailing Address - Fax:615-261-1222
Practice Address - Street 1:95 SEABOARD LN
Practice Address - Street 2:SUITE 201
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3031
Practice Address - Country:US
Practice Address - Phone:615-261-1214
Practice Address - Fax:615-261-1222
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-03-09
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Provider Licenses
StateLicense IDTaxonomies
TN28614208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3897346Medicaid
TN3897346Medicaid