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General NPI Number Information
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NPI Number | 1427129014
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Entity Type | Individual
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Provider Name | LEANNE HARRIS MARTINELLI PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 2745 DEKALB MEDICAL PKWY SUITE 110
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City | LITHONIA
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State | GA
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Zip | 30058-4932
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Country | US
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Telephone | 770-981-5431
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Fax | 770-981-5515
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Provider Business Mailing Address
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Address Line | 1835 SAVOY DR SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30341-1072
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Country | US
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Telephone | 770-495-3396
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Fax | 770-495-2307
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 004312
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13486
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License Number State | NC
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