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General NPI Number Information
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NPI Number | 1033494372
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Entity Type | Organization
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Legal Business Name | LEAP ONE ENTERPRISE PLLC
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 5160 GALAXIE DR
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City | JACKSON
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State | MS
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Zip | 39206-4308
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Country | US
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Telephone | 615-525-1019
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Fax | 601-366-3415
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Provider Business Mailing Address
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Address Line | 5160 GALAXIE DR
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City | JACKSON
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State | MS
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Zip | 39206-4308
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Country | US
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Telephone | 615-525-1019
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Fax | 601-366-3415
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | FOSTER LAGINA C
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Credential | MD
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Telephone | 615-525-1019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 21249
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License Number State | MS
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