Provider Demographics
NPI:1609879501
Name:EVERETT, LEON ELDON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:ELDON
Last Name:EVERETT
Suffix:
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 1:184 PROSSER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4233
Mailing Address - Country:US
Mailing Address - Phone:931-762-1800
Mailing Address - Fax:931-762-9155
Practice Address - Street 1:184 PROSSER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4233
Practice Address - Country:US
Practice Address - Phone:931-762-1800
Practice Address - Fax:931-762-9155
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3184611Medicaid
TN080150685OtherRAILROAD MEDICARE
TNBO4142Medicare UPIN
TN3184611Medicaid