Provider Demographics
NPI:1285604801
Name:LEBLANC, HARVEY PAUL JR (MD)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:PAUL
Last Name:LEBLANC
Suffix:JR
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 1:109 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2067
Mailing Address - Country:US
Mailing Address - Phone:706-625-0333
Mailing Address - Fax:706-625-1269
Practice Address - Street 1:109 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2067
Practice Address - Country:US
Practice Address - Phone:706-625-0333
Practice Address - Fax:706-625-1269
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00251501BMedicaid
GA00251501BMedicaid
GA20208I3133Medicare PIN