Individual provider Active NPI

Desiree Diana Jana Leverette

  • Neonatal-Perinatal Medicine Physician
  • Atlanta, GA
National Provider Identifier
1891379897
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
100293 Issued in GA
Practice address
1405 Clifton Rd NE
Atlanta, GA 30322-3220
Phone
(404) 785-5437
NPI assigned
May 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neonatal-Perinatal Medicine Physician 2080N0001X 100293 GA Primary

Addresses

Primary practice location

1405 Clifton Rd NE
Atlanta, GA 30322-3220

Mailing address

765 Dunlop Way
Atlanta, GA 30312-3726
Phone (334) 649-9377

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210622002345 CT Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 8022419571
I20240626000457 GA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 8022419571

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
100293GAMDNeonatal-Perinatal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1891379897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 DUNLOP WAY",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303123726",
            "telephone_number": "334-649-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303223220",
            "telephone_number": "404-785-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVERETTE",
        "first_name": "DESIREE",
        "middle_name": "DIANA JANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-06",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "GA",
            "license": "100293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.