Healthcare Provider Details

I. General information

NPI: 1720499775
Provider Name (Legal Business Name): JONATHAN SAWAYA LEKOSHERE D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3981 HIGHWAY 9
BOILING SPRINGS SC
29316-8578
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-560-3650
  • Fax: 864-560-3675
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83474
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: