person
Johnathan Tyree Dietrich Lee, PA-C
Medical Physician Assistant in Norfolk, Virginia
NPI 1790165686

Johnathan Tyree Dietrich Lee is a Medical Physician Assistant based in Norfolk, VA and is specialized in Medical. Johnathan Tyree Dietrich Lee practices in Norfolk, VA and has the professional credentials of PA-C. The NPI Number for Johnathan Tyree Dietrich Lee is 1790165686 and holds a License No. 0110005004 (Virginia).

The current practice location address for Johnathan Tyree Dietrich Lee is 6333 Center Dr, Norfolk, VA and can be reached out via phone at 540-448-0719.

Location: 6333 Center Dr, Norfolk, VA, 23502-4126
person
Provider Profile Details
NPI Number
1790165686
Provider Name
Johnathan Tyree Dietrich Lee
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
6333 Center Dr, Norfolk, VA, 23502-4126
Phone Number
540-448-0719
Fax Number
Provider Enumeration Date
06/04/2015
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0110005004 01 VA VIRGINIA MEDICAL LICENSE
institution
Provider Business Practice Location Address Details
Address
6333 Center Dr
City
State
Zip
23502-4126
Phone Number
540-448-0719
Fax Number
person
Provider Business Mailing Address Details
Address
6333 Center Dr
City
State
Zip
23502-4126
Phone Number
540-448-0719
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
0110005004 (Virginia)
Definition
Definition to come...
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