Provider Demographics
NPI:1336534924
Name:TATY, LEONDRIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LEONDRIA
Middle Name:
Last Name:TATY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 POST RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-1537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2929 POST RD
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:GA
Practice Address - Zip Code:30187-1537
Practice Address - Country:US
Practice Address - Phone:404-220-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2016-07-06
Deactivation Date:2015-12-07
Deactivation Code:
Reactivation Date:2016-04-19
Provider Licenses
StateLicense IDTaxonomies
GARN200676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily