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General NPI Number Information
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NPI Number | 1578843454
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Entity Type | Organization
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Legal Business Name | NEONATAL SPECIALIST OF GEORGIA
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 700 MEDICAL CENTER BLVD GWINNETT WOMENS PAVILION
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7693
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Country | US
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Telephone | 770-921-4492
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Fax | 770-696-3358
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Provider Business Mailing Address
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Address Line | PO BOX 2606
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City | LILBURN
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State | GA
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Zip | 30048-2606
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Country | US
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Telephone | 770-921-4492
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Fax | 770-696-3358
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LESLIE DENNIS LEIGH
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Credential | M.D.
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Telephone | 770-921-4492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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