Healthcare Provider Details

I. General information

NPI: 1740982446
Provider Name (Legal Business Name): LEONARDO VILLANUEVA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 EXECUTIVE PARK DR
CLINTON TN
37716-6876
US

IV. Provider business mailing address

110 EXECUTIVE PARK DR
CLINTON TN
37716-6876
US

V. Phone/Fax

Practice location:
  • Phone: 865-494-9241
  • Fax: 865-374-2121
Mailing address:
  • Phone: 865-494-9241
  • Fax: 865-374-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7082
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: