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General NPI Number Information
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NPI Number | 1619576931
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Entity Type | Individual
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Provider Name | DZINTRA LEBLANC NP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 2154 JOHNSON FERRY RD NE
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City | BROOKHAVEN
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State | GA
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Zip | 30319-2558
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Country | US
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Telephone | 404-948-3019
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Fax |
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Provider Business Mailing Address
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Address Line | 2583 BALLEW CT NE
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City | MARIETTA
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State | GA
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Zip | 30062-4424
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Country | US
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Telephone | 678-650-4188
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 225127
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License Number State | GA
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