Healthcare Provider Details

I. General information

NPI: 1467637611
Provider Name (Legal Business Name): LENTZ PEDIATRICS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 HIGHWAY 412 W
LEXINGTON TN
38351-6283
US

IV. Provider business mailing address

19 SECURITY DR
JACKSON TN
38305-3626
US

V. Phone/Fax

Practice location:
  • Phone: 731-968-5558
  • Fax: 731-968-5567
Mailing address:
  • Phone: 731-664-9040
  • Fax: 731-664-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31704
License Number StateTN

VIII. Authorized Official

Name: MR. JONATHAN D LENTZ
Title or Position: PHYSICIAN
Credential: MD
Phone: 731-664-9040