Provider Demographics
NPI:1225508542
Name:LEON, BREONNA (NP)
Entity type:Individual
Prefix:MRS
First Name:BREONNA
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4598 BARCLAY DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5883
Mailing Address - Country:US
Mailing Address - Phone:770-796-5069
Mailing Address - Fax:404-521-4344
Practice Address - Street 1:4598 BARCLAY DR
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5883
Practice Address - Country:US
Practice Address - Phone:770-796-5069
Practice Address - Fax:404-521-4344
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20230872932084A0401X
GARN244563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine