Healthcare Provider Details

I. General information

NPI: 1255913380
Provider Name (Legal Business Name): JACLYN LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 MEDICAL CENTER EAST-SOUTH TOWER 1215 21ST AVE. SOUTH
NASHVILLE TN
37232-8605
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE STE 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-6180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1026282
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: