Doctor Name: | MR. LEO POULIOT |
NPI Number: | 1073979753 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP-C |
License Number: | RN226487 |
Business Practice Address: | 101 Mayo St Suite B Americus, GA - 317093695 |
Business Phone Number: | 2299288355 |
Business Fax Number: | 2299288358 |
Mailing Address: | 101 Mayo St, Suite B AMERICUS |
State: | GA |
Postal Code: | 317093695 |
Phone Number: | 2299288355 |
Fax Number: | |
NPI Enumeration Date: | 01/11/2016 |
NPI Last Update Date: | 01/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN226487 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |