MEDICARE: LEO OVADJE 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	207RN0300X	Nephrology Physician	055143	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	:	1386635795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO OVADJE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2130
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-8909
Country	:	US
Telephone Number	:	678-284-0800
Fax Number	:	678-284-0393

Provider Business Practice Location Address
First Line	:	105 N PARK TRL
Second Line	:	SUITE 300
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7373
Country	:	US
Telephone Number	:	678-284-0800
Fax Number	:	678-284-0393

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/08/2007

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