MEDICARE: MRS. LESLEIGH JOHANN THOMAS PA

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	363A00000X	Physician Assistant	0010-11419	NC

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	:	1962071415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLEIGH JOHANN THOMAS PA

Provider Business Mailing Address
First Line	:	1085 NE GATEWAY CT NE STE 100
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1085 NE GATEWAY CT NE STE 180
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2407
Country	:	US
Telephone Number	:	704-707-2200
Fax Number	:

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

Provider Enumeration Date	:	06/20/2021
Last Update Date	:	02/21/2023

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