Healthcare Provider Details

I. General information

NPI: 1891952602
Provider Name (Legal Business Name): LEANDREA CRISTIS LOCKRIDGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 FOUNTAIN VALLEY DR SUITE 350
KNOXVILLE TN
37918-5327
US

IV. Provider business mailing address

PO BOX 440082
NASHVILLE TN
37244-0082
US

V. Phone/Fax

Practice location:
  • Phone: 865-925-9035
  • Fax: 865-925-9045
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48267
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: