Provider Demographics
NPI:1427129014
Name:MARTINELLI, LEANNE HARRIS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:HARRIS
Last Name:MARTINELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-495-3396
Mailing Address - Fax:770-495-2307
Practice Address - Street 1:2745 DEKALB MEDICAL PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4932
Practice Address - Country:US
Practice Address - Phone:770-981-5431
Practice Address - Fax:770-981-5515
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004312363AM0700X
NC13486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACA9328OtherMEDICARE GROUP-DMERC
GA108178463AMedicaid
GA202I976810Medicare PIN