Provider Demographics
NPI:1194967646
Name:LEONARD, GEORGE LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LOUIS
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SCOTT STATION CV
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-3613
Mailing Address - Country:US
Mailing Address - Phone:228-822-2291
Mailing Address - Fax:
Practice Address - Street 1:26 SCOTT STATION CV
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3613
Practice Address - Country:US
Practice Address - Phone:228-822-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14757208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice