Healthcare Provider Details

I. General information

NPI: 1871406033
Provider Name (Legal Business Name): ANDREW LEATHERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 FORSYTH RD
SAVANNAH GA
31406-2126
US

IV. Provider business mailing address

1538 FORSYTH RD
SAVANNAH GA
31406-2126
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-2637
  • Fax:
Mailing address:
  • Phone: 912-819-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN282084
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: