Healthcare Provider Details

I. General information

NPI: 1679678403
Provider Name (Legal Business Name): JONATHAN CLAY LOCKHART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 BAYLOR DR
LONGVIEW TX
75601-4404
US

IV. Provider business mailing address

807 BAYLOR DR
LONGVIEW TX
75601-4404
US

V. Phone/Fax

Practice location:
  • Phone: 903-295-8990
  • Fax: 903-295-8987
Mailing address:
  • Phone: 903-295-8990
  • Fax: 903-295-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberJ8644
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: