Healthcare Provider Details

I. General information

NPI: 1427170687
Provider Name (Legal Business Name): LEON HUGHES JR. CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 CHRIS LAKE DRIVE
LAWRENCEVILLE GA
30046
US

IV. Provider business mailing address

2100 RIVERSIDE PKWY STE 128
LAWRENCEVILLE GA
30043-5936
US

V. Phone/Fax

Practice location:
  • Phone: 678-464-4905
  • Fax:
Mailing address:
  • Phone: 678-464-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: