Provider Demographics
NPI:1982750402
Name:LEE, YUNG GIL (MD)
Entity Type:Individual
Prefix:
First Name:YUNG
Middle Name:GIL
Last Name:LEE
Suffix:
Gender:M
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 725
Mailing Address - Street 2:315 GRADY RD
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331
Mailing Address - Country:US
Mailing Address - Phone:423-263-5400
Mailing Address - Fax:423-263-0674
Practice Address - Street 1:315 GRADY RD
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331
Practice Address - Country:US
Practice Address - Phone:423-263-5400
Practice Address - Fax:423-263-0674
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD007963208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3152995Medicaid
B02436Medicare UPIN
3152995Medicare ID - Type Unspecified