Provider Demographics
NPI:1184004103
Name:MACKLIN, LEAH EVE MICKELSON (DO)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:EVE MICKELSON
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:EVE
Other - Last Name:MICKELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2860 RONALD REAGAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6092
Mailing Address - Country:US
Mailing Address - Phone:470-215-1920
Mailing Address - Fax:470-253-7923
Practice Address - Street 1:2860 RONALD REAGAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6092
Practice Address - Country:US
Practice Address - Phone:470-215-1920
Practice Address - Fax:470-253-7923
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC209826207Q00000X
GA79851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine