Provider Demographics
NPI: | 1871835942 |
---|---|
Name: | LEE, JENNIFER (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JENNIFER |
Middle Name: | |
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: | PO BOX 1000 DEPT 351 |
Mailing Address - Street 2: | |
Mailing Address - City: | MEMPHIS |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 38148-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 901-758-9900 |
Mailing Address - Fax: | 901-752-2335 |
Practice Address - Street 1: | 4250 BETHEL RD |
Practice Address - Street 2: | |
Practice Address - City: | OLIVE BRANCH |
Practice Address - State: | MS |
Practice Address - Zip Code: | 38654-8737 |
Practice Address - Country: | US |
Practice Address - Phone: | 901-516-1290 |
Practice Address - Fax: | 901-516-1220 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2013-03-26 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MS | 24968 | 207R00000X, 208000000X, 208M00000X |
390200000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |