MEDICARE: PAUL J. LEAVITT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD0000038410	TN

General Provider Information

NPI Number	:	1578615522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J. LEAVITT M.D.

Provider Business Mailing Address
First Line	:	353 NEW SHACKLE ISLAND RD STE 140C
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2366
Country	:	US
Telephone Number	:	615-826-5664
Fax Number	:	615-826-5665

Provider Business Practice Location Address
First Line	:	353 NEW SHACKLE ISLAND RD STE 140C
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2366
Country	:	US
Telephone Number	:	615-826-5664
Fax Number	:	615-826-5665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/02/2021

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