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General NPI Number Information
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NPI Number | 1346413077
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Entity Type | Organization
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Legal Business Name | LEAVITT FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 353 NEW SHACKLE ISLAND RD SUITE 103A
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2379
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Country | US
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Telephone | 615-826-5664
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Fax | 615-826-5665
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Provider Business Mailing Address
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Address Line | 353 NEW SHACKLE ISLAND RD SUITE 103A
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2931
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Country | US
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Telephone | 615-826-5664
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Fax | 615-826-5665
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Authorized Official
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Title or Position | FAMILY PHYSICIAN
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Name | DR. PAUL JASON LEAVITT
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Credential | M.D.
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Telephone | 615-826-5664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD0000038410
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License Number State | TN
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