Provider Demographics
NPI:1679678403
Name:LOCKHART, JONATHAN CLAY (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CLAY
Last Name:LOCKHART
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 1:807 BAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4404
Mailing Address - Country:US
Mailing Address - Phone:903-295-8990
Mailing Address - Fax:903-295-8987
Practice Address - Street 1:807 BAYLOR DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4404
Practice Address - Country:US
Practice Address - Phone:903-295-8990
Practice Address - Fax:903-295-8987
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ86442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029732701Medicaid
00171DMedicare Oscar/Certification