Provider Demographics
NPI:1760419196
Name:LEE, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:ONE VANTAGE WAY STE B240
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1562
Mailing Address - Country:US
Mailing Address - Phone:615-515-8160
Mailing Address - Fax:615-327-4403
Practice Address - Street 1:2000 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-0001
Practice Address - Country:US
Practice Address - Phone:615-284-8469
Practice Address - Fax:615-284-3854
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN9021207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4040147OtherBLUECROSS
TN3167991Medicaid
TN3110213OtherSTONES RIVER IPA
KY64747470OtherKY MEDICAID
TN3167995Medicare ID - Type Unspecified
TN3167991Medicaid