Provider Demographics
NPI:1578843454
Name:NEONATAL SPECIALIST OF GEORGIA
Entity Type:Organization
Organization Name:NEONATAL SPECIALIST OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-921-4492
Mailing Address - Street 1:PO BOX 2606
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30048-2606
Mailing Address - Country:US
Mailing Address - Phone:770-921-4492
Mailing Address - Fax:770-696-3358
Practice Address - Street 1:700 MEDICAL CENTER BLVD
Practice Address - Street 2:GWINNETT WOMENS PAVILION
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7693
Practice Address - Country:US
Practice Address - Phone:770-921-4492
Practice Address - Fax:770-696-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000700983FMedicaid
GA322060OtherLEIGH @ WELLCARE
GA117057Medicaid
GA117063OtherLEIGH @ PEACHSTATE
GA803486775GMedicaid
GA000593425GMedicaid
GA083668065KMedicaid
GA000593425CMedicaid
GA000700983BMedicaid
GA000700983DMedicaid
GA10052477OtherLEIGH @ AMERIGROUP
GA10052477Medicaid
2504776OtherSUSKIN @ AETNA
GA803486775IMedicaid
2504633OtherLEIGH @ AETNA
52051429OtherLEIGH @ BLUE CROSS
GA803486775FMedicaid
GA322063Medicaid
52412187OtherSUSKIN @ BLUE CROSS
GA000593425DMedicaid
GA083668065JMedicaid
GA083668065MMedicaid