Provider Demographics
NPI:1669467981
Name:LENNON, DAVID M (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:LENNON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681789
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1789
Mailing Address - Country:US
Mailing Address - Phone:615-260-9570
Mailing Address - Fax:
Practice Address - Street 1:725 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2702
Practice Address - Country:US
Practice Address - Phone:615-503-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1669467981Medicaid
TN3663717Medicaid
NC1669467981Medicaid
TN3663717Medicaid
NCNCC915D540Medicare PIN
TN3663718OtherMEDICARE - LEBANON BACK PAIN CLINIC, P.C.
TN4154784OtherBC/BS - SHELBYVILLE
TN3663717OtherMEDICARE - CUMBERLAND BACK PAIN CLINIC, P.C.
TN4139726OtherBC/BS - CROSSVILLE
TNPA0000000060OtherSTATE LICENSE
Q50255Medicare UPIN