Provider Demographics
NPI:1225504632
Name:SWEETEN, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SWEETEN
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 1:470 KNOLL WOODS TER
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3417
Mailing Address - Country:US
Mailing Address - Phone:404-205-4228
Mailing Address - Fax:
Practice Address - Street 1:1395 S MARIETTA PKWY SE STE 116
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7852
Practice Address - Country:US
Practice Address - Phone:678-932-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA195297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily