Healthcare Provider Details

I. General information

NPI: 1356499032
Provider Name (Legal Business Name): LEE JUNG CARDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ALCOA HWY E40
KNOXVILLE TN
37920-2244
US

IV. Provider business mailing address

2009 SWEETWOOD LN
KNOXVILLE TN
37932-1958
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-5510
  • Fax: 865-305-5515
Mailing address:
  • Phone: 865-692-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number30599
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: