Provider Demographics
NPI:1104301233
Name:LEACH, QUINCY ADAM (AGACNP)
Entity type:Individual
Prefix:MR
First Name:QUINCY
Middle Name:ADAM
Last Name:LEACH
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 S ANNISTON AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2904
Mailing Address - Country:US
Mailing Address - Phone:256-872-7777
Mailing Address - Fax:256-249-0863
Practice Address - Street 1:126 S ANNISTON AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2904
Practice Address - Country:US
Practice Address - Phone:256-872-7777
Practice Address - Fax:256-249-0863
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-076889363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care