Provider Demographics
NPI:1417184771
Name:LESHANSKI, KATRINA MCCLANE (DO)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:MCCLANE
Last Name:LESHANSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0407
Mailing Address - Country:US
Mailing Address - Phone:912-535-5581
Mailing Address - Fax:912-535-5457
Practice Address - Street 1:125 CHURCH ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4770
Practice Address - Country:US
Practice Address - Phone:912-538-8484
Practice Address - Fax:912-538-8665
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202657208000000X
FLOS14200208000000X, 208M00000X
GA081732208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist