Basic Information
| Provider Information | |||||||||
| NPI: | 1902021041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACLEOD | ||||||||
| FirstName: | W | ||||||||
| MiddleName: | ERIC | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 E. DERENNE AVE | ||||||||
| Address2: | ATTN: HOPE SAMS | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126445300 | ||||||||
| FaxNumber: | 9126443369 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 DOCTORS DRIVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | DOUGLAS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123836575 | ||||||||
| FaxNumber: | 9123836476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 02/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 053861 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207QS0010X | 053861 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 594551065E | 05 | GA | MEDICAID | 594551065C | 05 | GA | MEDICAID | 594551065B | 05 | GA | MEDICAID | 594551065D | 05 | GA | MEDICAID | 5945510656 | 05 | GA | MEDICAID | 594551065A | 05 | GA | MEDICAID |