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General NPI Number Information
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NPI Number | 1114992260
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Entity Type | Individual
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Provider Name | CHARLES EDWIN LEONARD M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 1171 HIGHWAY 11 E SUITE 101
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City | TALBOTT
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State | TN
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Zip | 37877-3137
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Country | US
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Telephone | 865-475-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1171 HIGHWAY 11 E SUITE 101
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City | TALBOTT
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State | TN
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Zip | 37877-3137
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Country | US
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Telephone | 865-475-2400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 122284
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License Number State | TN
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