Individual
DR. MITCHEL ALTMAN LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1765 OLD WEST BROAD ST, ATHENS, GA 30606-2853
(706) 549-1663
(706) 546-8792
Mailing address
1765 OLD WEST BROAD ST BLDG 2-200, ATHENS, GA 30606-2887
(706) 549-1663
(706) 546-8792
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
76160
GA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
76160
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14015888
CAQH NUMBER
—
Enumeration date
12/17/2008
Last updated
03/11/2024
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