Provider Demographics
NPI:1215095351
Name:GWINNETT NEONATOLOGY,PC
Entity type:Organization
Organization Name:GWINNETT NEONATOLOGY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-921-4492
Mailing Address - Street 1:PO BOX 2606
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30048-2606
Mailing Address - Country:US
Mailing Address - Phone:770-921-4492
Mailing Address - Fax:770-696-3358
Practice Address - Street 1:700 MEDICAL CENTER BLVD
Practice Address - Street 2:GWINNETT WOMENS PAVILION
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7693
Practice Address - Country:US
Practice Address - Phone:770-921-4492
Practice Address - Fax:770-696-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA117057Medicaid
GA52051429OtherLEIGH AT BLUE CROSS
GA52412187OtherSUSKIN AT BLUE CROSS
GA2504776OtherSUSKIN AT AETNA
GA000593425CMedicaid
GA083668065LMedicaid
GA083668065MMedicaid
GA10052477Medicaid
GA300032702AMedicaid
GA000700983BMedicaid
GA000593425DMedicaid
GA000700983DMedicaid
GA083668065JMedicaid
GA083668065KMedicaid
GA2504633OtherLEIGH AT AETNA
GA322060Medicaid
GA322063Medicaid
GA117063Medicaid