Individual
DR. LEIV M TAKLE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
646 S 8TH ST, GRIFFIN, GA 30224-4214
(770) 228-3836
Mailing address
646 S 8TH ST, GRIFFIN, GA 30224-4214
(770) 228-3836
(770) 412-1733
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
057850
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180697446C
—
GA
Enumeration date
07/06/2006
Last updated
04/24/2017
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