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General NPI Number Information
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NPI Number | 1750331476
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Entity Type | Individual
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Provider Name | STEPHEN HUNT LEATHERWOOD PA
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 550 REDMOND RD NW
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City | ROME
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State | GA
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Zip | 30165-1416
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Country | US
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Telephone | 706-233-8512
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Fax | 706-233-8513
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Provider Business Mailing Address
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Address Line | 1825 MARTHA BERRY BLVD NW
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City | ROME
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State | GA
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Zip | 30165-1625
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Country | US
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Telephone | 706-295-5331
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 005118
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License Number State | GA
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