Healthcare Provider Details

I. General information

NPI: 1255034831
Provider Name (Legal Business Name): LEO ZHENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 MARIETTA BLVD NW STE 450
ATLANTA GA
30318-2004
US

IV. Provider business mailing address

13637 CYGNUS DR
ORLANDO FL
32828-9325
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-4400
  • Fax:
Mailing address:
  • Phone: 407-683-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number112251
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: