Provider Demographics
NPI:1023227584
Name:HIGGINBOTHAM, LEAH R (DO)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:R
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-547-9400
Mailing Address - Fax:423-547-9401
Practice Address - Street 1:1503 W ELK AVE STE 12
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2883
Practice Address - Country:US
Practice Address - Phone:423-547-9400
Practice Address - Fax:423-547-9401
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TND01857208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000368Medicaid