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NPI Code Detail

MEDICARE: HEATHER LEISY MD, MBA, MPH

MEDICARE: HEATHER LEISY MD, MBA, MPH
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
12083P0901XPublic Health & General Preventive Medicine PhysicianMD52531SC
22083P0901XPublic Health & General Preventive Medicine Physician193607CA

General Provider Information

NPI Number : 1942590518
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER LEISY MD, MBA, MPH
Provider Business Mailing Address
First Line : 360 N IRBY ST
Second Line :
City : FLORENCE
State : SC
Zip : 29501-2808
Country : US
Telephone Number : 843-667-9414
Fax Number : 843-667-1362
Provider Business Practice Location Address
First Line : 4301 X ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95817-2214
Country : US
Telephone Number : 800-282-3284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2011
Last Update Date : 08/08/2024

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