Leodez

General Practice Physician · Tucker, GA

Organization Active NPI

NPI number 1255933115

Practice location

4292 Chamblee Tucker Rd
Tucker, GA 30084-2103
Phone
(770) 718-1517

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NPI record

NPI
1255933115
Entity type
Organization (Type 2)
Enumeration date
November 14, 2020
Last updated
November 14, 2020
Certified
November 14, 2020
Organization subpart
Yes
Parent organization
B Mata LLC

Specialties & taxonomy codes

TaxonomyCodeLicenseState
General Practice Physician Primary 208D00000X — —
Adult Medicine Physician 207QA0505X — —
Geriatric Medicine (Family Medicine) Physician 207QG0300X — —

Mailing address

3899 Grassland Loop
Lake Mary, FL 32746-4120
Phone
(407) 394-2645

Authorized official

Name
Dr. Byron Oswaldo Mata, MD
Title
Owner
Phone
(786) 427-4450

Other names

  • Centro Medico San Lucas

About Leodez

Leodez is a healthcare organization registered in the NPI registry with the primary taxonomy General Practice Physician (code 208D00000X). The practice location is 4292 Chamblee Tucker Rd, Tucker, GA 30084-2103. The NPI number 1255933115 was assigned on November 14, 2020 and the record was last updated on November 14, 2020.

The authorized official for this organization is Dr. Byron Oswaldo Mata, MD, Owner.

Frequently asked questions

What is the NPI number of Leodez?

The NPI number is 1255933115.

What is the phone number of Leodez?

The phone number listed for the practice location is (770) 718-1517.

Where is Leodez located?

4292 Chamblee Tucker Rd, Tucker, GA 30084-2103.

What is the taxonomy code for Leodez?

The primary taxonomy code is 208D00000X – General Practice Physician; 2 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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