MEDICARE: DR. GARY G. LEONHARDT 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	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	39296	NC

General Provider Information

NPI Number	:	1538183942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY G. LEONHARDT M.D.

Provider Business Mailing Address
First Line	:	4300 SAPPHIRE CT STE 110
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-9079
Country	:	US
Telephone Number	:	252-830-7561
Fax Number	:	252-413-0932

Provider Business Practice Location Address
First Line	:	203 GOVERNMENT CIR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-8198
Country	:	US
Telephone Number	:	252-413-1637
Fax Number	:	252-317-0316

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/14/2015

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