Provider Demographics
NPI:1508848169
Name:LEFTWICH, LANNY M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LANNY
Middle Name:M
Last Name:LEFTWICH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GREAT CIRCLE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228
Mailing Address - Country:US
Mailing Address - Phone:931-738-9211
Mailing Address - Fax:931-738-4330
Practice Address - Street 1:509 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1707
Practice Address - Country:US
Practice Address - Phone:931-520-8435
Practice Address - Fax:931-372-7225
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000350212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3327418Medicaid
TN3327418Medicare ID - Type Unspecified
TN3327418Medicaid