Individual
LEIA MARLENA THORNTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2650 GUNTER PARK DRIVE EAST, MONTGOMERY, AL 36109
(334) 523-6395
(334) 523-6390
Mailing address
2650 GUNTER PARK DR EAST, MONTGOMERY, AL 36109
(334) 523-6395
(334) 523-6390
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA435
AL
363AM0700X
Medical Physician Assistant
PA435
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009936221
—
AL
05
—
06437010
—
MS
05
—
1504297
—
FL
01
—
51533432
BCBS
AL
Enumeration date
05/20/2006
Last updated
08/30/2024
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