Provider Demographics
NPI:1821034208
Name:GEORGE, LELAND E (PA)
Entity type:Individual
Prefix:
First Name:LELAND
Middle Name:E
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PA
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Other - Middle Name:
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Mailing Address - Street 1:4416 FOREST DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-3104
Mailing Address - Country:US
Mailing Address - Phone:803-782-4278
Mailing Address - Fax:803-782-3445
Practice Address - Street 1:110 ATRIUM WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6301
Practice Address - Country:US
Practice Address - Phone:803-788-1153
Practice Address - Fax:803-736-3243
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P21641Medicare UPIN