Provider Demographics
NPI:1215045216
Name:LEIGH, GEORGE GARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GARY
Last Name:LEIGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-0802
Mailing Address - Country:US
Mailing Address - Phone:423-553-7560
Mailing Address - Fax:423-648-9291
Practice Address - Street 1:7155 LEE HWY STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-0802
Practice Address - Country:US
Practice Address - Phone:423-648-9290
Practice Address - Fax:423-648-9291
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNP590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0017400OtherBLUE CROSS
TN3682315Medicaid
TN0017400OtherBLUE CROSS