Individual
LEVERETT C NEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1104 MARTHA BERRY BLVD NE, ROME, GA 30165-1612
(706) 291-2077
Mailing address
1104 MARTHA BERRY BLVD NE, ROME, GA 30165-1612
(706) 291-2077
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
062145
GA
2085R0202X
Diagnostic Radiology Physician
Primary
062145
GA
2085U0001X
Diagnostic Ultrasound Physician
062145
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
581088313A
MEDICARE GROUP PROVIDER #
GA
Enumeration date
11/16/2007
Last updated
08/07/2009
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