Provider Demographics
NPI:1396700605
Name:LEAMY, GREGORY J (PA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:LEAMY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:37 MEDICAL PARK LOOP STE 103
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5277
Mailing Address - Country:US
Mailing Address - Phone:828-586-7910
Mailing Address - Fax:828-586-7911
Practice Address - Street 1:37 MEDICAL PARK LOOP STE 103
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779
Practice Address - Country:US
Practice Address - Phone:828-586-7910
Practice Address - Fax:828-586-7911
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101321363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970016088OtherRAILROAD
NC2745545Medicare PIN
NC970016088OtherRAILROAD