Provider Demographics
NPI:1801807201
Name:KOVALICK-LEGGETT, DEBORAH ANN (R)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:KOVALICK-LEGGETT
Suffix:
Gender:F
Credentials:R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4149 JULIETTE RD
Mailing Address - Street 2:
Mailing Address - City:JULIETTE
Mailing Address - State:GA
Mailing Address - Zip Code:31046-4700
Mailing Address - Country:US
Mailing Address - Phone:478-994-2772
Mailing Address - Fax:
Practice Address - Street 1:1504 HARDEMAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1416
Practice Address - Country:US
Practice Address - Phone:478-745-3135
Practice Address - Fax:478-745-3136
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314047247100000X, 2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography