Basic Information
Provider Information | |||||||||
NPI: | 1871553487 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEVERT | ||||||||
FirstName: | FRANCIS | ||||||||
MiddleName: | EDWARD | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | II | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4275 JOHNS CREEK PKWY | ||||||||
Address2: | SUITE A | ||||||||
City: | SUWANEE | ||||||||
State: | GA | ||||||||
PostalCode: | 300249117 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6784751606 | ||||||||
FaxNumber: | 6784751615 | ||||||||
Practice Location | |||||||||
Address1: | 4275 JOHNS CREEK PKWY | ||||||||
Address2: | SUITE A | ||||||||
City: | SUWANEE | ||||||||
State: | GA | ||||||||
PostalCode: | 300249117 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6784751606 | ||||||||
FaxNumber: | 6784751615 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/27/2006 | ||||||||
LastUpdateDate: | 07/13/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 053469 | GA | Y |   | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 1588721435 | 01 |   | GROUP NPI | OTHER | CB5609 | 01 |   | RAILROAD MEDICARE | OTHER |