Provider Demographics
NPI:1962855809
Name:GOOD, LEONARD (LPN)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:GOOD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SAINT IVES DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8917
Mailing Address - Country:US
Mailing Address - Phone:717-314-5436
Mailing Address - Fax:
Practice Address - Street 1:126 SAINT IVES DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-8917
Practice Address - Country:US
Practice Address - Phone:717-314-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN092654164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse