Provider Demographics
NPI:1275812760
Name:POMBO, LEAH GALLOWAY (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:GALLOWAY
Last Name:POMBO
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 OLD IVY RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2939
Mailing Address - Country:US
Mailing Address - Phone:678-779-3041
Mailing Address - Fax:
Practice Address - Street 1:9 DUNWOODY PARK STE 108
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6712
Practice Address - Country:US
Practice Address - Phone:770-393-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA180804363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology