Individual
MR. RYAN D LEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 836-9666
Mailing address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 836-9666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006051
GA
363AM0700X
Medical Physician Assistant
006051
GA
Other
Enumeration date
02/05/2011
Last updated
02/26/2011
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