Provider Demographics
NPI:1124009097
Name:MCCLUSKEY, LELAND CHESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:CHESTER
Last Name:MCCLUSKEY
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 7217
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7217
Mailing Address - Country:US
Mailing Address - Phone:706-322-6646
Mailing Address - Fax:706-322-2891
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:SUITE 101A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-322-6646
Practice Address - Fax:706-322-2891
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032608207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939872Medicaid
GA000506448Medicaid
GA20NCCRCOtherMEDICARE PTAN
GA20BBFJFMedicare ID - Type Unspecified
GACJ5373Medicare ID - Type UnspecifiedGROUP RAILROAD MEDICARE
GAGRP4161Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
AL009973590Medicaid
GA158727900OtherDEPARTMENT OF LABOR
GA205202OtherBLUE CROSS
AL529909670Medicaid
GA4923347OtherCIGNA
GA200043124Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AL468185OtherGROUP BLUE CROSS
GA00506448IMedicaid