Individual
MARY KATHERINE LEOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
780 JOHNSON FERRY RD STE 100, ATLANTA, GA 30342-1434
(404) 661-6865
(404) 829-1312
Mailing address
2359 LIME ROCK RD, VESTAVIA HILLS, AL 35216-3006
(205) 533-3386
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10697
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
08/17/2020
Last updated
04/04/2022
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