Provider Demographics
NPI:1366481244
Name:LEAPHART, WILFREIDA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:WILFREIDA
Middle Name:LYNN
Last Name:LEAPHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6268
Mailing Address - Country:US
Mailing Address - Phone:912-350-5970
Mailing Address - Fax:912-350-3374
Practice Address - Street 1:4750 WATERS AVE STE 302
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6268
Practice Address - Country:US
Practice Address - Phone:912-350-5970
Practice Address - Fax:912-350-3374
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35680207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
160051156OtherRAILROAD MEDICARE
GA000750615GMedicaid
GA926702OtherBLUE CROSS BLUE SHIELD
GA000750615EMedicaid
SCG35680Medicaid
GA000750615FMedicaid
582162071007OtherCHAMPUS
GA000750615BMedicaid
GA000750615CMedicaid
GA00750615BMedicaid
F93646Medicare UPIN
GA000750615CMedicaid