SOUTHLAND SPORTS MEDICINE AND WELLNESS, INC. (NPI# 1487671475) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487671475 |
| Entity Type | Organization |
| Organization Name | SOUTHLAND SPORTS MEDICINE AND WELLNESS, INC. |
| Practice Address |
809 E Main St Blue Ridge GA 30513-4575 |
| Practice Telephone | 7066322200 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MARK LESKI (OWNER/ PHYSICIAN) |
| Authorized Official Telephone | 7066322200 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207Q00000X | Family Medicine | 33624 | GA | Allopathic & Osteopathic Physicians |
| X | 2081S0010X |
Physical Medicine & Rehabilitation Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
809 E MAIN ST |
| City | BLUE RIDGE |
| State | GA |
| Zip Code | 30513-4575 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902238843 | Sarah Romines Cleckler | Family Medicine | 809 E Main St, Blue Ridge, GA 30513-4575 | 2013-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356804561 | Christine Gangwisch | Registered Nurse | 3855 Old Highway 5 Ste 110, Blue Ridge, GA 30513 | 2019-04-13 |
| 1013474659 | Ten Dental LLC | Dentist | 330 Progress Circle Ste C, Blue Ridge, GA 30513 | 2019-03-01 |
| 1932646262 | David Lee Durham | Pharmacist | 5679 Appalachian Highway, Blue Ridge, GA 30513 | 2017-01-25 |
| 1659754398 | Jordan Patton | Ophthalmology | 266 Orvin Lance Dr Ste 5, Blue Ridge, GA 30513 | 2015-06-30 |
| 1063824977 | Christy Russell | Pharmacist | 97 Commerce Drive, Blue Ridge, GA 30513 | 2014-05-27 |
| 1588008429 | Nathan William Kincaid | Surgery | 2855 Old Highway 5 Ste 108, Blue Ridge, GA 30513 | 2013-04-22 |
| 1972800175 | W. Max Couch, Jr., Dds, Mds, LLC | Dentist | 2714 East First Street, Blue Ridge, GA 30513 | 2011-02-24 |
| 1760792246 | Med-trans Corporation | Ambulance | 482 Mccaysville Industrial Dr, Blue Ridge, GA 30513 | 2010-10-18 |
| 1396924791 | Sue Ann Richardson | Chiropractor | 59 Mckinney, Blue Ridge, GA 30513 | 2007-11-01 |
| 1164554432 | Pruitthealth Home First, Inc. | Case Management | 6050 Appalachian Highway, Suite 4, Blue Ridge, GA 30513 | 2007-03-12 |
| Find all providers in zip 30513 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407052160 | Neal Chander Tah | Family Medicine | 101 Riverstone Vis Ste 211, Blue Ridge, GA 30513-6665 | 2007-06-21 |
| 1093821019 | Stefanie Lee Shaver | Family Medicine | 980 E Main St, Suite 300, Blue Ridge, GA 30513-7139 | 2006-08-22 |
| 1104848977 | Kenney Scott Atkins | Family Medicine | 4799 Blue Ridge Dr, Suite 100, Blue Ridge, GA 30513-3240 | 2006-07-24 |
| 1265436539 | Gary W Hunt | Family Medicine | 2855 Old Highway 5, Ste 104, Blue Ridge, GA 30513-6239 | 2005-06-02 |
| 1073516621 | Hidden Valley Medical Center Inc | Family Medicine | 101 Riverstone Vis Ste 300, Blue Ridge, GA 30513-6683 | 2005-05-27 |
| 1619302387 | Georgia Integrated Healthcare, LLC | Family Medicine | 980 E Main St, Suite 300, Blue Ridge, GA 30513-7139 | 2013-09-12 |
| 1902238843 | Sarah Romines Cleckler | Family Medicine | 809 E Main St, Blue Ridge, GA 30513-4575 | 2013-08-02 |
| 1386929222 | Marc S Berger Md PC | Family Medicine | 101 Riverstone Vis, Ste 217, Blue Ridge, GA 30513-6648 | 2011-10-11 |
| 1730405069 | Shaver Medical, PC | Family Medicine | 980 E Main St, Suite #300, Blue Ridge, GA 30513-7139 | 2010-04-12 |
| 1407027782 | Charles Wessinger Duke | Family Medicine | 101 Riverstone Vista, Suite 106, Blue Ridge, GA 30153-6631 | 2008-03-14 |
| Find all providers in BLUE RIDGE | ||||
| City | BLUE RIDGE |
| Zip Code | 30513 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.