Individual
JONATHAN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6800
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6800
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
T-2979
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02832791
—
MS
Enumeration date
06/12/2015
Last updated
10/26/2015
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