Provider Demographics
NPI:1942590518
Name:LEISY, HEATHER (MD, MBA, MPH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LEISY
Suffix:
Gender:F
Credentials:MD, MBA, MPH
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:LEISY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:360 N IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2808
Mailing Address - Country:US
Mailing Address - Phone:843-667-9414
Mailing Address - Fax:843-667-1362
Practice Address - Street 1:360 N IRBY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-667-9414
Practice Address - Fax:843-667-1362
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD525312083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine