Healthcare Provider Details

I. General information

NPI: 1427076991
Provider Name (Legal Business Name): JOHN SHERWOOD LEITE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8134 COUNTRY VILLAGE DR SUITE 102
CORDOVA TN
38016-2029
US

IV. Provider business mailing address

PO BOX 341065
BARTLETT TN
38184-1065
US

V. Phone/Fax

Practice location:
  • Phone: 901-756-8398
  • Fax: 901-756-8701
Mailing address:
  • Phone: 901-385-2342
  • Fax: 901-382-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP726
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: