Provider Demographics
NPI:1891761151
Name:LEROY, JOSEPH B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:B
Last Name:LEROY
Suffix:
Gender:M
Credentials:MD
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 1378
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1378
Mailing Address - Country:US
Mailing Address - Phone:229-227-2990
Mailing Address - Fax:
Practice Address - Street 1:400S PINETREE BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7128
Practice Address - Country:US
Practice Address - Phone:229-227-2990
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0336232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDBVQMedicare ID - Type UnspecifiedMEDICARE
GAC68385Medicare UPIN
GA260021571Medicare ID - Type UnspecifiedMEDICARE RAILROAD