Healthcare Provider Details

I. General information

NPI: 1255518890
Provider Name (Legal Business Name): LEAH LORD HELTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 FAIRVIEW PARK DR
DUBLIN GA
31021
US

IV. Provider business mailing address

102 BOWLING LN
DUBLIN GA
31021-2502
US

V. Phone/Fax

Practice location:
  • Phone: 478-304-1414
  • Fax:
Mailing address:
  • Phone: 478-272-0203
  • Fax: 478-272-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number001824
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: