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NPI Code Detail

MEDICARE: LEISHA BROGDON

MEDICARE: LEISHA BROGDON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1538626536
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEISHA BROGDON
Provider Business Mailing Address
First Line : 5921 BEMISS RD
Second Line :
City : VALDOSTA
State : GA
Zip : 31605-7520
Country : US
Telephone Number : 352-284-6057
Fax Number :
Provider Business Practice Location Address
First Line : 5921 BEMISS RD
Second Line :
City : VALDOSTA
State : GA
Zip : 31605-7520
Country : US
Telephone Number : 352-284-6057
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2019
Last Update Date : 02/26/2019

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Directions to “ LEISHA BROGDON ” Practice Location

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