MEDICARE: LEONE P CORDLE PA-C

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
1	363AM0700X	Medical Physician Assistant	001992	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639153810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONE P CORDLE PA-C

Provider Business Mailing Address
First Line	:	126 THREE RIVERS DR NE
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-4999
Country	:	US
Telephone Number	:	706-295-0070
Fax Number	:	706-235-1618

Provider Business Practice Location Address
First Line	:	126 THREE RIVERS DR NE
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-4999
Country	:	US
Telephone Number	:	706-295-0070
Fax Number	:	706-235-1618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/26/2015

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Directions to “ LEONE P CORDLE PA-C” Practice Location

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