Active NPI
Leiv Munlaug Takle, MD
- Ophthalmology Physician
- Griffin, GA
National Provider Identifier
1447201074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 15043
- Practice address
- 646 S 8TH St
Griffin, GA 30224 - Phone
- (770) 228-3836
- Fax
- (770) 412-1733
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 15043 | GA | Primary |
Addresses
Primary practice location
646 S 8TH St
Griffin, GA 30224
Mailing address
646 S 8TH St
Griffin, GA 30224
Phone (770) 228-3836
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000088877A | Medicaid | GA | |
| 0706580001 | Other | DMEPOS MEDICARE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15043 | GA | MD | Ophthalmology Physician |
Interoperability endpoints
- leiv.takle.p1@direct.teg.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196812800000",
"number": "1447201074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "646 S 8TH ST",
"city": "GRIFFIN",
"state": "GA",
"postal_code": "30224",
"telephone_number": "770-228-3836",
"fax_number": "770-412-1733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "646 S 8TH ST",
"city": "GRIFFIN",
"state": "GA",
"postal_code": "30224",
"telephone_number": "770-228-3836",
"fax_number": "770-412-1733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAKLE",
"first_name": "LEIV",
"middle_name": "MUNLAUG",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2007-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "GA",
"license": "15043",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000088877A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMEPOS MEDICARE #",
"identifier": "0706580001",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Griffin, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.