Individual
MARIAN LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
4700 NELSON BROGDON BLVD STE 250, BUFORD, GA 30518-5415
(770) 442-1911
Mailing address
1090 WESTCROFT LN, ROSWELL, GA 30075-6020
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
—
GA
Other
Enumeration date
09/06/2018
Last updated
06/27/2022
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