Provider Demographics
NPI:1093336687
Name:HARBOR, LEANNA ELISE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:ELISE
Last Name:HARBOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N COBB ST STE 230
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7162
Mailing Address - Country:US
Mailing Address - Phone:478-453-9383
Mailing Address - Fax:
Practice Address - Street 1:750 N COBB ST STE 230
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7162
Practice Address - Country:US
Practice Address - Phone:478-453-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics