Individual
LEVI SAMUEL WIDENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
245 MEDICAL PARK DR STE B, MARION, VA 24354
(276) 378-3020
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 952-2111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110008072
VA
363A00000X
Physician Assistant
Primary
4743
TN
Other
Enumeration date
08/19/2021
Last updated
12/05/2025
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