Individual provider · Type 1 NPI

Johnathan Tyree Dietrich Lee, PA-C

Medical Physician Assistant · Norfolk, VA

NPI number 1790165686 Active

Practice location

6333 Center Dr, Interstate Corporate Center # 16
Norfolk, VA 23502-4126

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X0110005004 (VA)
Medical Physician Assistant 363AM0700XNone listed

Medical Physician Assistant: Definition to come...

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About NPI 1790165686

Johnathan Tyree Dietrich Lee, PA-C's National Provider Identifier is 1790165686, issued on Jun 4, 2015. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Norfolk, VA. The record was last updated on Mar 12, 2021.