Individual
FERNANDA LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5916 E LAKE PKWY STE 285, MCDONOUGH, GA 30253-4802
(470) 781-1209
(470) 200-3305
Mailing address
5916 E LAKE PKWY STE 285, MCDONOUGH, GA 30253-4802
(470) 781-1209
(470) 200-3305
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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