Healthcare Provider Details

I. General information

NPI: 1093325474
Provider Name (Legal Business Name): LEORA E BUTCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 MONTREAL RD
TUCKER GA
30084-6724
US

IV. Provider business mailing address

1321 MURFREESBORO PIKE STE 702
NASHVILLE TN
37217-2679
US

V. Phone/Fax

Practice location:
  • Phone: 404-480-3842
  • Fax: 615-577-5654
Mailing address:
  • Phone: 844-359-7629
  • Fax: 615-577-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90691
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: