Healthcare Provider Details

I. General information

NPI: 1427011485
Provider Name (Legal Business Name): THOMAS ALLAN LEONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 S HIGHWAY 14 STE 1200L
GREER SC
29650-4902
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-849-9150
  • Fax: 864-849-9334
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number31292
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: