Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 032608 | GA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 032608 | GA |
NPI | 1124009097 |
---|---|
Provider Name | Dr. Leland Chester Mccluskey |
First Address | Columbus, GA 31908-7217 |
Second Address | Columbus, GA 31904-6802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 24/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000506448 | (05) | GA |
009939872 | (05) | AL |
20NCCRC | MEDICARE PTAN (01) | GA |