MEDICARE: MARSHA V LEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD26113	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4656078	OTHER	TN	AETNA
2	3171381	OTHER	TN	CIGNA
3	4052655	OTHER	TN	BCBS, TN

General Provider Information

NPI Number	:	1134112766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA V LEE M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 405827
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-5827
Country	:	US
Telephone Number	:	901-226-3172
Fax Number	:	901-226-3160

Provider Business Practice Location Address
First Line	:	8950 HWY 64
Second Line	:	SUITE 116
City	:	LAKELAND
State	:	TN
Zip	:	38002
Country	:	US
Telephone Number	:	901-383-7170
Fax Number	:	901-388-6478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	05/24/2012

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