Provider Demographics
NPI:1700042132
Name:IMHOF, PRESTON LEIGH (DO)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:LEIGH
Last Name:IMHOF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 LENOX RD NE
Mailing Address - Street 2:#30
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-6025
Mailing Address - Country:US
Mailing Address - Phone:417-825-3482
Mailing Address - Fax:
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:SUITE 707
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-501-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69331207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery