Active NPI
John Lee, LICSW
- Clinical Social Worker
- Chattanooga, TN
National Provider Identifier
1063564516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 5575
- Practice address
- 3085 Broad St
Suite I
Chattanooga, TN 37408-3084 - Phone
- (423) 248-2482
- Fax
- (888) 420-3050
- NPI assigned
- Jan 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 113374 | MA | |
| Clinical Social Worker | 1041C0700X | 211886 | ||
| Clinical Social Worker | 1041C0700X | 5575 | TN | Primary |
Addresses
Primary practice location
3085 Broad St
Suite I
Chattanooga, TN 37408-3084
Mailing address
3085 Broad St
Suite I
Chattanooga, TN 37408-3084
Phone (423) 248-2482
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113374 | MA | MD | Clinical Social Worker |
| 5575 | TN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335571200000",
"number": "1063564516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3085 BROAD ST",
"address_2": "SUITE I",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374083084",
"telephone_number": "423-248-2482",
"fax_number": "888-420-3050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3085 BROAD ST",
"address_2": "SUITE I",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374083084",
"telephone_number": "423-248-2482",
"fax_number": "888-420-3050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JOHN",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-17",
"last_updated": "2012-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "113374",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": "211886",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "5575",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.