Provider Demographics
NPI:1023200847
Name:JONATHAN C. LOCKHART, MD
Entity Type:Organization
Organization Name:JONATHAN C. LOCKHART, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-295-8994
Mailing Address - Street 1:911 W LOOP 281
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2900
Mailing Address - Country:US
Mailing Address - Phone:903-295-8994
Mailing Address - Fax:903-295-8987
Practice Address - Street 1:911 W LOOP 281
Practice Address - Street 2:SUITE 111
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2900
Practice Address - Country:US
Practice Address - Phone:903-295-8994
Practice Address - Fax:903-295-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ86442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00171DMedicare PIN