MEDICARE: DR. DERRELL LEVOHN LEGGETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	133964	NC
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	66346	GA
3	208VP0014X	Interventional Pain Medicine Physician	66346	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306025630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERRELL LEVOHN LEGGETT M.D.

Provider Business Mailing Address
First Line	:	794 MCDONOUGH RD
Second Line	:	SUITE 108
City	:	JACKSON
State	:	GA
Zip	:	30233-1572
Country	:	US
Telephone Number	:	470-251-5300
Fax Number	:	470-251-5301

Provider Business Practice Location Address
First Line	:	794 MCDONOUGH RD
Second Line	:	SUITE 108
City	:	JACKSON
State	:	GA
Zip	:	30233-1572
Country	:	US
Telephone Number	:	470-251-5300
Fax Number	:	470-251-5301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	05/24/2022

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Directions to “ DR. DERRELL LEVOHN LEGGETT M.D.” Practice Location

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