Provider Demographics
NPI:1073624912
Name:FRANGIPANE, LEO G JR (MD)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:G
Last Name:FRANGIPANE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30539-0009
Mailing Address - Country:US
Mailing Address - Phone:706-515-1090
Mailing Address - Fax:706-515-1093
Practice Address - Street 1:765 MADDOX DR
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8189
Practice Address - Country:US
Practice Address - Phone:706-515-1090
Practice Address - Fax:706-515-1093
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA053812208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA196171338AMedicaid
B33256Medicare UPIN
GA196171338AMedicaid