| Doctor Name: | LEONDRIA TATY |
| NPI Number: | 1336534924 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | RN200676 |
| Business Practice Address: | 2929 Post Rd Winston, GA - 301871537 |
| Business Phone Number: | 7702547400 |
| Business Fax Number: | |
| Mailing Address: | 2929 Post Rd, WINSTON |
| State: | GA |
| Postal Code: | 301871537 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/01/2015 |
| NPI Last Update Date: | 04/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 12/07/2015 |
| NPI Reactivation Date: | 04/19/2016 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN200676 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |