Individual
MR. JESSE RAYMOND LECLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 FREEDOM WAY, VAMC-DD, THORACIC SURGERY, ROUTING # 22, AUGUSTA, GA 30904-6258
(706) 733-0188
(706) 823-3983
Mailing address
460 ASHRIDGE WAY, AUGUSTA, GA 30907-4916
(706) 860-3753
(706) 823-3983
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
002936
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1008230
NCCPA CERTFICATE NUMBER
—
Enumeration date
08/03/2006
Last updated
07/08/2007
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