Provider Demographics
NPI:1740862762
Name:HARTPENCE, LEAH FAITH (APRN)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:FAITH
Last Name:HARTPENCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 MOUNT ZION RD STE C4
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1583
Mailing Address - Country:US
Mailing Address - Phone:770-968-1746
Mailing Address - Fax:
Practice Address - Street 1:696 MOUNT ZION RD STE C4
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1583
Practice Address - Country:US
Practice Address - Phone:770-968-1746
Practice Address - Fax:770-968-0727
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN103159363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care