Provider Demographics
NPI:1629628276
Name:ASHBY, LEANDRA (MEDS)
Entity Type:Individual
Prefix:
First Name:LEANDRA
Middle Name:
Last Name:ASHBY
Suffix:
Gender:F
Credentials:MEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 PINEBARK WAY
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1767
Mailing Address - Country:US
Mailing Address - Phone:404-845-6498
Mailing Address - Fax:
Practice Address - Street 1:6420 PINEBARK WAY
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1767
Practice Address - Country:US
Practice Address - Phone:404-845-6498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor