MEDICARE: NATHANIEL J LEE MD

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	207P00000X	Emergency Medicine Physician	MD40547	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00274067	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407960222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL J LEE MD

Provider Business Mailing Address
First Line	:	PO BOX 5576
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37602-5576
Country	:	US
Telephone Number	:	423-926-6266
Fax Number	:	423-926-7599

Provider Business Practice Location Address
First Line	:	1319 SUNSET DR
Second Line	:	SUITE 201
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-3799
Country	:	US
Telephone Number	:	423-926-6266
Fax Number	:	423-926-7599

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	03/18/2011

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Directions to “ NATHANIEL J LEE MD” Practice Location

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