Provider Demographics
NPI:1962265918
Name:MAY, LEANDER JACOB (SA-C)
Entity type:Individual
Prefix:
First Name:LEANDER
Middle Name:JACOB
Last Name:MAY
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 STONEBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-0111
Mailing Address - Country:US
Mailing Address - Phone:678-643-2187
Mailing Address - Fax:
Practice Address - Street 1:68 STONEBROOK CIR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-0111
Practice Address - Country:US
Practice Address - Phone:678-643-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24-132246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant