Healthcare Provider Details

I. General information

NPI: 1215095351
Provider Name (Legal Business Name): GWINNETT NEONATOLOGY,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MEDICAL CENTER BLVD GWINNETT WOMENS PAVILION
LAWRENCEVILLE GA
30045-7693
US

IV. Provider business mailing address

PO BOX 2606
LILBURN GA
30048-2606
US

V. Phone/Fax

Practice location:
  • Phone: 770-921-4492
  • Fax: 770-696-3358
Mailing address:
  • Phone: 770-921-4492
  • Fax: 770-696-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLIE DENNIS LEIGH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 770-921-4492