Provider Demographics
NPI:1659044840
Name:LEOPARD, CECELIA MULLINS
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:MULLINS
Last Name:LEOPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CECELIA
Other - Middle Name:
Other - Last Name:BRANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 GOLD MILL PL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-4025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 GOLD MILL PL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4025
Practice Address - Country:US
Practice Address - Phone:703-400-5518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist