MEDICARE: LEE KINSEY THORNTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	15860	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043318280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE KINSEY THORNTON M.D.

Provider Business Mailing Address
First Line	:	1200 22ND AVE
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-4009
Country	:	US
Telephone Number	:	601-693-7742
Fax Number	:	601-693-7758

Provider Business Practice Location Address
First Line	:	5002 HIGHWAY 39 N BLDG C
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-1078
Country	:	US
Telephone Number	:	601-693-7742
Fax Number	:	601-693-7758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/12/2020

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