Provider Demographics
NPI:1730197047
Name:LECLAIR, JESSE RAYMOND (PA-C)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:RAYMOND
Last Name:LECLAIR
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:460 ASHRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4916
Mailing Address - Country:US
Mailing Address - Phone:706-860-3753
Mailing Address - Fax:706-823-3983
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:VAMC-DD, THORACIC SURGERY, ROUTING # 22
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-823-3983
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA002936363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1008230OtherNCCPA CERTFICATE NUMBER