Healthcare Provider Details

I. General information

NPI: 1902759822
Provider Name (Legal Business Name): ANNA GARCIA LEATHERWOOD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 WARWICK DR
MACON GA
31210-1540
US

IV. Provider business mailing address

1024 WARWICK DR
MACON GA
31210-1540
US

V. Phone/Fax

Practice location:
  • Phone: 478-361-0570
  • Fax:
Mailing address:
  • Phone: 478-361-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP292513
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: