Provider Demographics
NPI:1235793670
Name:CHISHOLM JOHNSON, LEAH (MD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:CHISHOLM JOHNSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:CHISHOLM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6335 HOSPITAL PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5809
Mailing Address - Country:US
Mailing Address - Phone:404-778-4898
Mailing Address - Fax:404-813-5572
Practice Address - Street 1:1161 21ST AVE SOUTH
Practice Address - Street 2:A-1302 MEDICAL CENTER NORTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2765
Practice Address - Country:US
Practice Address - Phone:615-322-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA102554208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program