Provider Demographics
NPI:1093492993
Name:LEACH, MELISSA ANNETTE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNETTE
Last Name:LEACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 WYLIE DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7536
Mailing Address - Country:US
Mailing Address - Phone:770-485-1855
Mailing Address - Fax:
Practice Address - Street 1:1380 WYLIE DR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7536
Practice Address - Country:US
Practice Address - Phone:770-485-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG