Basic Information
| Provider Information | |||||||||
| NPI: | 1508848169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEFTWICH | ||||||||
| FirstName: | LANNY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 GREAT CIRCLE ROAD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317389211 | ||||||||
| FaxNumber: | 9317384330 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 N CEDAR AVE | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385011707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315208435 | ||||||||
| FaxNumber: | 9313727225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 08/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD0000035021 | TN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 3327418 | 05 | TN | MEDICAID |