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NPI Code Detail

MEDICARE: DR. KATRINA MCCLANE LESHANSKI D.O.

MEDICARE: DR. KATRINA MCCLANE LESHANSKI D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician0102202657VA
2208000000XPediatrics PhysicianOS14200FL
3208M00000XHospitalist Physician081732GA
4208M00000XHospitalist PhysicianOS14200FL
5208000000XPediatrics Physician081732GA

General Provider Information

NPI Number : 1417184771
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATRINA MCCLANE LESHANSKI D.O.
Provider Business Mailing Address
First Line : PO BOX 407
Second Line :
City : VIDALIA
State : GA
Zip : 30475-0407
Country : US
Telephone Number : 912-535-5581
Fax Number : 912-535-5457
Provider Business Practice Location Address
First Line : 125 CHURCH ST
Second Line :
City : VIDALIA
State : GA
Zip : 30474-4770
Country : US
Telephone Number : 912-538-8484
Fax Number : 912-538-8665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2009
Last Update Date : 10/17/2019

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