Healthcare Provider Details

I. General information

NPI: 1588868293
Provider Name (Legal Business Name): BARBARA MILLER LEVERETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1807
US

IV. Provider business mailing address

1245 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1807
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-0389
  • Fax: 706-651-0729
Mailing address:
  • Phone: 706-868-0389
  • Fax: 706-651-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number068930
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: