Healthcare Provider Details

I. General information

NPI: 1487784344
Provider Name (Legal Business Name): JAMES EARL LEE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/09/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 27TH ST RM 5S
NEW YORK NY
10001-6208
US

IV. Provider business mailing address

4 GLENGROVE DR
SIMPSONVILLE SC
29681-3667
US

V. Phone/Fax

Practice location:
  • Phone: 917-634-5311
  • Fax: 888-815-3583
Mailing address:
  • Phone: 833-351-8255
  • Fax: 888-815-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number25823
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25823
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: