Healthcare Provider Details

I. General information

NPI: 1851317671
Provider Name (Legal Business Name): MARK H LEECH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 GUNBARREL RD SUITE 103
CHATTANOOGA TN
37421-4136
US

IV. Provider business mailing address

1616 GUNBARREL RD SUITE 103
CHATTANOOGA TN
37421-4136
US

V. Phone/Fax

Practice location:
  • Phone: 423-826-8200
  • Fax: 423-826-8201
Mailing address:
  • Phone: 423-826-8200
  • Fax: 423-826-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD0000018072
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: