Healthcare Provider Details

I. General information

NPI: 1023155546
Provider Name (Legal Business Name): JO LEE DEVANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N OCOEE ST LEE UNIVERSITY HEALTH CLINIC
CLEVELAND TN
37311-4458
US

IV. Provider business mailing address

3011 CHESTNUT CIR NW
CLEVELAND TN
37312-2110
US

V. Phone/Fax

Practice location:
  • Phone: 423-614-8430
  • Fax:
Mailing address:
  • Phone: 423-478-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number012009
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: