Provider Demographics
NPI:1366499634
Name:LEONOR-GILRANE, MARIXIE Q (MD)
Entity Type:Individual
Prefix:
First Name:MARIXIE
Middle Name:Q
Last Name:LEONOR-GILRANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIXIE
Other - Middle Name:Q
Other - Last Name:GILRANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:239 VILLAGE CENTER PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9024
Mailing Address - Country:US
Mailing Address - Phone:770-506-0095
Mailing Address - Fax:770-506-8060
Practice Address - Street 1:239 VILLAGE CENTER PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9024
Practice Address - Country:US
Practice Address - Phone:770-506-0095
Practice Address - Fax:770-506-8060
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0971235OtherAETNA
582262190OtherCIGNA
582262190OtherUHC
582262190OtherKAISER
GA000576122DMedicaid
52480810OtherBCBS
GA6051OtherPEACH STATE
GA10033072OtherAMERIGROUP
582262190OtherHUMANA TRICARE
GA6051OtherWELLCARE