Basic Information
| Provider Information | |||||||||
| NPI: | 1609879501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVERETT | ||||||||
| FirstName: | LEON | ||||||||
| MiddleName: | ELDON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 PROSSER RD | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384644233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317621800 | ||||||||
| FaxNumber: | 9317629155 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 PROSSER RD | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384644233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317621800 | ||||||||
| FaxNumber: | 9317629155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 02/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD13175 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3184611 | 05 | TN | MEDICAID | 080150685 | 01 | TN | RAILROAD MEDICARE | OTHER |