Healthcare Provider Details

I. General information

NPI: 1225252125
Provider Name (Legal Business Name): LEE MICHAEL PERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6734 LEE HWY
CHATTANOOGA TN
37421-2423
US

IV. Provider business mailing address

6734 LEE HWY
CHATTANOOGA TN
37421-2423
US

V. Phone/Fax

Practice location:
  • Phone: 423-899-0431
  • Fax: 423-499-9552
Mailing address:
  • Phone: 423-899-0431
  • Fax: 423-499-9552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number000510
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number44699
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: