Provider Demographics
NPI:1902081755
Name:MANE, LEENA PRAVIN (MD)
Entity Type:Individual
Prefix:
First Name:LEENA
Middle Name:PRAVIN
Last Name:MANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEENA
Other - Middle Name:AJITRAO
Other - Last Name:MORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 DUNWOODY PARK
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7408
Mailing Address - Country:US
Mailing Address - Phone:404-778-6920
Mailing Address - Fax:
Practice Address - Street 1:11 DUNWOODY PARK
Practice Address - Street 2:SUITE 150
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7408
Practice Address - Country:US
Practice Address - Phone:404-778-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine