Provider Demographics
NPI:1831418631
Name:CLARK D. LEA, M.D., P.C.
Entity type:Organization
Organization Name:CLARK D. LEA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-284-2532
Mailing Address - Street 1:300 20TH AVE N STE G3
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2132
Mailing Address - Country:US
Mailing Address - Phone:615-284-2532
Mailing Address - Fax:615-284-2533
Practice Address - Street 1:300 20TH AVE N STE G3
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2132
Practice Address - Country:US
Practice Address - Phone:615-284-2532
Practice Address - Fax:615-284-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty