Provider Demographics
NPI:1447645130
Name:LECONTE MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:LECONTE MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMALEA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:423-773-9555
Mailing Address - Street 1:598 JOHN DEERE DR
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-3212
Mailing Address - Country:US
Mailing Address - Phone:865-745-1869
Mailing Address - Fax:865-745-1873
Practice Address - Street 1:129 S GAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37902-1004
Practice Address - Country:US
Practice Address - Phone:865-745-1869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN15811261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care