Healthcare Provider Details

I. General information

NPI: 1538183942
Provider Name (Legal Business Name): GARY G. LEONHARDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 GOVERNMENT CIR
GREENVILLE NC
27834-8198
US

IV. Provider business mailing address

4300 SAPPHIRE CT STE 110
GREENVILLE NC
27834-9079
US

V. Phone/Fax

Practice location:
  • Phone: 252-413-1637
  • Fax: 252-317-0316
Mailing address:
  • Phone: 252-830-7561
  • Fax: 252-413-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number39296
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: