Provider Demographics
NPI:1972390607
Name:TAYLOR, LEEANNE DUBOIS
Entity type:Individual
Prefix:
First Name:LEEANNE
Middle Name:DUBOIS
Last Name:TAYLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LEEANNE
Other - Middle Name:MARIE
Other - Last Name:DUBOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 S VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-1772
Mailing Address - Country:US
Mailing Address - Phone:912-654-9647
Mailing Address - Fax:
Practice Address - Street 1:402 S VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-1772
Practice Address - Country:US
Practice Address - Phone:912-654-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist