Provider Demographics
NPI:1568645315
Name:JOHNSON, LEIGH GOSSICK (PHD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:GOSSICK
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NEALY AVENUE
Mailing Address - Street 2:1ST MEDICAL GROUP
Mailing Address - City:LANGLEY AFB
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2033
Mailing Address - Country:US
Mailing Address - Phone:757-764-6840
Mailing Address - Fax:757-764-9597
Practice Address - Street 1:77 NEALY AVENUE
Practice Address - Street 2:1ST MEDICAL GROUP
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-2033
Practice Address - Country:US
Practice Address - Phone:757-764-6840
Practice Address - Fax:757-764-9597
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program