Basic Information
| Provider Information | |||||||||
| NPI: | 1396883716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENAZ | ||||||||
| FirstName: | LEONA | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1835 SAVOY DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303411072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705908311 | ||||||||
| FaxNumber: | 7705908313 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 CHURCH ST NE STE 335 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300608957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705908311 | ||||||||
| FaxNumber: | 7705908313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN11010191 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | RN193714 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 349156122A | 05 | GA | MEDICAID | 202I503405 | 01 | GA | MEDICARE PTAN | OTHER | 349156122C | 05 | GA | MEDICAID | 349156122R | 05 | GA | MEDICAID | 109754200 | 05 | FL | MEDICAID | 349156122V | 05 | GA | MEDICAID |