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General NPI Number Information
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NPI Number | 1588226849
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Entity Type | Individual
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Provider Name | FREDRICK CURTIS LEAK
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Gender | Male
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Dates
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Enumeration Date | 07/07/2019
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Last Update Date | 07/07/2019
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Provider Practice Location Address
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Address Line | 500 N MCPHERSON CHURCH RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-0278
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Country | US
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Telephone | 910-867-5141
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Fax |
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Provider Business Mailing Address
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Address Line | 500 N MCPHERSON CHURCH RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-0278
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Country | US
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Telephone | 910-867-5141
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 26755
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License Number State | NC
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