Provider Demographics
NPI:1154866382
Name:LEONARD, CAMILLA POTTS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLA
Middle Name:POTTS
Last Name:LEONARD
Suffix:
Gender:F
Credentials:PA-C
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 200
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-0200
Mailing Address - Country:US
Mailing Address - Phone:336-940-5716
Mailing Address - Fax:
Practice Address - Street 1:1616 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7406
Practice Address - Country:US
Practice Address - Phone:336-940-5716
Practice Address - Fax:336-998-8111
Is Sole Proprietor?:No
Enumeration Date:2016-12-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06914363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical