Provider Demographics
NPI:1508994815
Name:LEADER, EDAWRD (MD)
Entity Type:Individual
Prefix:
First Name:EDAWRD
Middle Name:
Last Name:LEADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 GLENLAKE PKWY NE STE 1045
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3450
Mailing Address - Country:US
Mailing Address - Phone:770-399-9299
Mailing Address - Fax:770-399-5499
Practice Address - Street 1:1 GLENLAKE PKWY NE STE 1045
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3450
Practice Address - Country:US
Practice Address - Phone:770-399-9299
Practice Address - Fax:770-399-5499
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0120542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry