Provider Demographics
NPI:1497494280
Name:HENDRICKS, LEIGHANNA
Entity Type:Individual
Prefix:
First Name:LEIGHANNA
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEIGHANNA
Other - Middle Name:
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2635 TUCKER DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4314
Mailing Address - Country:US
Mailing Address - Phone:404-954-0988
Mailing Address - Fax:
Practice Address - Street 1:2635 TUCKER DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4314
Practice Address - Country:US
Practice Address - Phone:404-954-0988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist