Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jacob Cole Lee, PA-C

Individual provider Physician Assistant · NPI 1104431485

Jacob Cole Lee, PA-C is a Physician Assistant in Jackson, Mississippi. Qualified in 2020, 6 years ago. Practices with Mississippi Sports Medicine and Orthopaedic Center, a 73-clinician group, works from 3 locations and accepts Medicare assignment.

Years since qualifying
6
In the registry since
2020
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1325 E Fortification St
Jackson, MS 39202-2442
Phone: (601) 354-4488
Fax: (601) 351-5980
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 7545 Airways Blvd, Southaven, MS 38671-5806 — (901) 759-3100
  • 1400 S Germantown Rd, Germantown, TN 38138-2205 — (901) 759-3100

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1104431485
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 13, 2020
Last updated in NPPESMarch 13, 2025
Certification dateMarch 13, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Mississippi Sports Medicine And Orthopaedic Center — 73 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Jackson