Individual
JACOB COLE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1325 E FORTIFICATION ST, JACKSON, MS 39202-2442
(601) 354-4488
(601) 351-5980
Mailing address
1325 E FORTIFICATION ST, JACKSON, MS 39202-2442
(901) 759-3100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00827741
—
MS
05
—
Q063672
—
TN
Enumeration date
09/13/2020
Last updated
03/13/2025
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