Provider Demographics
NPI:1275717092
Name:LEGGETT, MICHAEL ARNEZ (IDC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ARNEZ
Last Name:LEGGETT
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 EAGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6133
Mailing Address - Country:US
Mailing Address - Phone:912-882-3839
Mailing Address - Fax:
Practice Address - Street 1:1063 USS GEORGIA AVE
Practice Address - Street 2:COMMANDER SUBMARINE GROUP TEN
Practice Address - City:KINGS BAY
Practice Address - State:GA
Practice Address - Zip Code:31558-2626
Practice Address - Country:US
Practice Address - Phone:912-409-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman