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General NPI Number Information
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NPI Number | 1932899259
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Entity Type | Individual
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Provider Name | MICHAEL E LEAHY
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Gender | Male
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 771 OLD NORCROSS RD STE 390
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4324
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Country | US
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Telephone | 678-957-0757
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Fax | 678-957-9597
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Provider Business Mailing Address
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Address Line | 3100 INTERSTATE NORTH CIR SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-2296
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Country | US
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Telephone | 770-953-6929
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12935
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License Number State | GA
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