Individual
LEELA MAXA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
311 PHILIP BLVD, LAWRENCEVILLE, GA 30046-8733
(770) 998-3000
(770) 995-1427
Mailing address
PO BOX 102215, ATLANTA, GA 30368-2215
(770) 995-3000
(770) 995-1427
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
037382
GA
2085R0001X
Radiation Oncology Physician
Primary
037382
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000564935G
—
GA
05
—
000564935O
—
GA
05
—
000564935P
—
GA
05
—
000564935Q
—
GA
05
—
000564935T
—
GA
05
—
00564935C
—
GA
01
—
511I920018
MEDICARE PROVIDER ID
GA
Enumeration date
12/01/2005
Last updated
06/03/2015
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