Provider Demographics
NPI:1720499775
Name:LEKOSHERE, JONATHAN SAWAYA (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SAWAYA
Last Name:LEKOSHERE
Suffix:
Gender:M
Credentials:DO
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:3981 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-8578
Practice Address - Country:US
Practice Address - Phone:864-560-3650
Practice Address - Fax:864-560-3675
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC834743Medicaid
SCSCK4355214OtherMEDICARE PIN