Provider Demographics
NPI:1205448032
Name:DORSEY, LEONA RAMSEY
Entity type:Individual
Prefix:
First Name:LEONA
Middle Name:RAMSEY
Last Name:DORSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SHEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-5316
Mailing Address - Country:US
Mailing Address - Phone:706-681-8669
Mailing Address - Fax:
Practice Address - Street 1:19 SHEARWATER DR
Practice Address - Street 2:
Practice Address - City:FORTSON
Practice Address - State:GA
Practice Address - Zip Code:31808-5316
Practice Address - Country:US
Practice Address - Phone:706-681-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20-1008171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty