Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 054452 | GA |
N | 207QA0505X | Family Doctor - Adult Medicine | 054452 | GA |
NPI | 1033198338 |
---|---|
Provider Name | Nichole Marie Leboyd |
First Address | Atlanta, GA 30303-2508 |
Second Address | Atlanta, GA 30303-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 03/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
083240704B | (05) | GA |
083240704C | (05) | GA |