Provider Demographics
NPI:1902021041
Name:MACLEOD, W ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:ERIC
Last Name:MACLEOD
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 1:210 E. DERENNE AVE
Mailing Address - Street 2:ATTN: HOPE SAMS
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-3369
Practice Address - Street 1:100 DOCTORS DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533
Practice Address - Country:US
Practice Address - Phone:912-383-6575
Practice Address - Fax:912-383-6476
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053861207X00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA594551065EMedicaid
GA594551065CMedicaid
GA594551065BMedicaid
GA594551065DMedicaid
GA5945510656Medicaid
GA594551065AMedicaid
GA594551065BMedicaid
GA594551065EMedicaid