Provider Demographics
NPI:1669431755
Name:LEROY, JOHN LEVIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEVIS
Last Name:LEROY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1731
Mailing Address - Country:US
Mailing Address - Phone:404-843-0840
Mailing Address - Fax:
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 375
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-843-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2010-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA028183208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00726228BMedicaid
GAF36527Medicare UPIN
GA00726228BMedicaid