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

Individual provider Medical Physician Assistant · NPI 1790165686

Johnathan Tyree Dietrich Lee, PA-C is a Physician Assistant in Norfolk, Virginia. Qualified in 2015, 11 years ago. Practices with Emergency Physicians of Tidewater, a 165-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
11
Licensed in
VA
In the registry since
2015
Specialties on file
2
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

6333 Center Dr Interstate Corporate Ctr # 16
Norfolk, VA 23502-4126
Phone: (540) 448-0719
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 0110005004 (VA)
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1790165686
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 4, 2015
Last updated in NPPESMarch 12, 2021
Certification dateMarch 12, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Emergency Physicians Of Tidewater — 165 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Norfolk