Healthcare Provider Details

I. General information

NPI: 1356436703
Provider Name (Legal Business Name): RODNEY OWEN LEACOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK DR STE 310
COLUMBIA SC
29203-6862
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8323
  • Fax: 803-296-8326
Mailing address:
  • Phone: 803-434-6412
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number200300373
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number35018
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: