Basic Information
| Provider Information | |||||||||
| NPI: | 1942355342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EL-CHOUFI | ||||||||
| FirstName: | LEYLA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1705 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309031705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067747760 | ||||||||
| FaxNumber: | 7067747766 | ||||||||
| Practice Location | |||||||||
| Address1: | 1303 DANTIGNAC ST | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067747760 | ||||||||
| FaxNumber: | 7067747766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD16530 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | 46594 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 00855181A | 05 | GA | MEDICAID | 110201975 | 01 | RAILROAD MEDICARE | OTHER | TL5840 | 05 | SC | MEDICAID | 11D0687551 | 01 | GROUP CLIA NUMBER | OTHER |