Provider Demographics
NPI:1629398623
Name:HARRIS, LEONIE V (PHD, NMD, ND)
Entity Type:Individual
Prefix:
First Name:LEONIE
Middle Name:V
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD, NMD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6203
Mailing Address - Country:US
Mailing Address - Phone:404-259-2206
Mailing Address - Fax:
Practice Address - Street 1:990 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6203
Practice Address - Country:US
Practice Address - Phone:404-259-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 175F00000X
GA000000133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education