MEDICARE: MR. STEPHEN HUNT LEATHERWOOD PA

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	005118	GA

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

NPI Number	:	1750331476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN HUNT LEATHERWOOD PA

Provider Business Mailing Address
First Line	:	1825 MARTHA BERRY BLVD NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1625
Country	:	US
Telephone Number	:	706-295-5331
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 REDMOND RD NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1416
Country	:	US
Telephone Number	:	706-233-8512
Fax Number	:	706-233-8513

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	08/24/2011

504 REDMOND RD NW
ROME, GA
30165-1416

Practice Phone: 706-235-3855
Practice Fax: 706-290-2382