Provider Demographics
NPI:1982271862
Name:LE, JOHNNY N (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:N
Last Name:LE
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:1055 PINE ST APT 126
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:999 GIRL SCOUT RD
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:TN
Practice Address - Zip Code:37029-9065
Practice Address - Country:US
Practice Address - Phone:615-570-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-09-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant