Provider Demographics
NPI:1568176048
Name:LEATHERLAND, LAUREN DUNCAN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DUNCAN
Last Name:LEATHERLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-1129
Mailing Address - Country:US
Mailing Address - Phone:706-580-0811
Mailing Address - Fax:
Practice Address - Street 1:802 22ND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8823
Practice Address - Country:US
Practice Address - Phone:706-576-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN289323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily