Provider Demographics
NPI:1073741500
Name:LEEP, CHAD ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ANTHONY
Last Name:LEEP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3611 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5002
Practice Address - Country:US
Practice Address - Phone:864-530-3500
Practice Address - Fax:864-560-3525
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC319293Medicaid
SCSC0288J577OtherMEDICARE PIN
SCSC02886067OtherMEDICARE PIN
SCSC02886084OtherMEDICARE PIN