Active NPI
Mary Katherine Leos
- Physician Assistant
- Atlanta, GA
National Provider Identifier
1821609447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10697
- Practice address
- 780 Johnson Ferry Rd Ste 100
Atlanta, GA 30342-1434 - Phone
- (404) 661-6865
- Fax
- (404) 829-1312
- NPI assigned
- Aug 17, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 10697 | GA | Primary |
Addresses
Primary practice location
780 Johnson Ferry Rd Ste 100
Atlanta, GA 30342-1434
Mailing address
2359 Lime Rock Rd
Vestavia Hills, AL 35216-3006
Phone (205) 533-3386
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10697 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Webb Plastic Surgery | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649030400000",
"number": "1821609447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2359 LIME ROCK RD",
"city": "VESTAVIA HILLS",
"state": "AL",
"postal_code": "352163006",
"telephone_number": "205-533-3386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "780 JOHNSON FERRY RD STE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303421434",
"telephone_number": "404-661-6865",
"fax_number": "404-829-1312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEOS",
"first_name": "MARY",
"middle_name": "KATHERINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-17",
"last_updated": "2022-04-04",
"certification_date": "2022-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "GA",
"license": "10697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.