Provider Demographics
NPI:1114191236
Name:LEIGH J MCKENZIE, LLC
Entity Type:Organization
Organization Name:LEIGH J MCKENZIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-852-0083
Mailing Address - Street 1:9 STOCKER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7415
Mailing Address - Country:US
Mailing Address - Phone:843-852-0083
Mailing Address - Fax:843-852-0087
Practice Address - Street 1:1064 GARDNER RD
Practice Address - Street 2:SUITE 112 A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5768
Practice Address - Country:US
Practice Address - Phone:843-852-0083
Practice Address - Fax:843-852-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty