Most Relevant Information
Provider Data
| NPI Number: | 1003501057 |
| Provider Name: | LEONA CAPEHART MEDLOCK PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 11077 |
Most Important Dates
| Enumeration Date: | 04/06/2023 |
| Last Updated: | 04/06/2023 |
Provider Practice Location
5270 PEACHTREE PKWY STE 107
PEACHTREE CORNERS
GA
300922558
Practice Location Phone/Fax
| Phone: | 7704161070 |
| Fax: |
Provider Mailing Location
5270 PEACHTREE PKWY STE 107
PEACHTREE CORNERS
GA
300922558
Provider Mailing Phone/Fax
| Phone: | 7704161070 |
| Fax: |