Provider Demographics
NPI:1336584291
Name:LEONARD, NICOLE RIE (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RIE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:RIE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:501 REDMOND RD NW DEPT OF
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1415
Mailing Address - Country:US
Mailing Address - Phone:706-236-4950
Mailing Address - Fax:
Practice Address - Street 1:501 REDMOND RD NW DEPT OF
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1415
Practice Address - Country:US
Practice Address - Phone:706-236-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204129207P00000X, 208D00000X
GA84478207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice