Provider Demographics
NPI:1629525969
Name:LEAF, JEREMY (DNP,FNP-BC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:LEAF
Suffix:
Gender:M
Credentials:DNP,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102038
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2038
Mailing Address - Country:US
Mailing Address - Phone:770-801-2500
Mailing Address - Fax:770-803-2121
Practice Address - Street 1:107 WALNUT LN STE 101
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-8629
Practice Address - Country:US
Practice Address - Phone:803-202-7159
Practice Address - Fax:803-202-7158
Is Sole Proprietor?:No
Enumeration Date:2016-09-03
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily