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General NPI Number Information
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NPI Number | 1275717092
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Entity Type | Individual
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Provider Name | MICHAEL ARNEZ LEGGETT IDC
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Gender | Male
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 1063 USS GEORGIA AVE COMMANDER SUBMARINE GROUP TEN
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City | KINGS BAY
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State | GA
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Zip | 31558-2626
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Country | US
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Telephone | 912-409-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 202 EAGLE BLVD
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City | KINGSLAND
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State | GA
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Zip | 31548-6133
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Country | US
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Telephone | 912-882-3839
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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 | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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