Provider Demographics
NPI:1699792572
Name:LACONTE, LEONARD PERRY (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:PERRY
Last Name:LACONTE
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 1:8 QUIET CV
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6512
Mailing Address - Country:US
Mailing Address - Phone:229-985-4748
Mailing Address - Fax:
Practice Address - Street 1:145 TECHNOLOGY PKWY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2913
Practice Address - Country:US
Practice Address - Phone:800-780-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0125082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00016684AMedicaid
GA30BDBCMMedicare ID - Type Unspecified
D30002Medicare UPIN