Provider Demographics
NPI:1962498758
Name:LEADER, JEANETTE DUREA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:DUREA
Last Name:LEADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:JEANETTE
Other - Last Name:DUREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:5780 PEACHTREE DUNWOODY ROAD
Practice Address - Street 2:SUITE 320
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1513
Practice Address - Country:US
Practice Address - Phone:404-256-2943
Practice Address - Fax:404-256-6027
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051283207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000951585AMedicaid
GA000951585FMedicaid
GA000951585BMedicaid
GA000951585BMedicaid