Healthcare Provider Details

I. General information

NPI: 1144750522
Provider Name (Legal Business Name): JONATHAN CHARLES LEVIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3744 WOODRUFF RD STE 3728
COLUMBUS GA
31904-5601
US

IV. Provider business mailing address

5224 75TH ST STE D
LUBBOCK TX
79424-2525
US

V. Phone/Fax

Practice location:
  • Phone: 706-686-0606
  • Fax:
Mailing address:
  • Phone: 806-712-1096
  • Fax: 806-771-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number02006642A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number114717
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: