Healthcare Provider Details

I. General information

NPI: 1427129014
Provider Name (Legal Business Name): LEANNE HARRIS MARTINELLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 DEKALB MEDICAL PKWY SUITE 110
LITHONIA GA
30058-4932
US

IV. Provider business mailing address

1835 SAVOY DR SUITE 300
ATLANTA GA
30341-1072
US

V. Phone/Fax

Practice location:
  • Phone: 770-981-5431
  • Fax: 770-981-5515
Mailing address:
  • Phone: 770-495-3396
  • Fax: 770-495-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004312
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13486
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: