Provider Demographics
NPI:1013180330
Name:LESLIE GASKILL, MD, LLC
Entity Type:Organization
Organization Name:LESLIE GASKILL, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-495-9995
Mailing Address - Street 1:6290 ABBOTTS BRIDGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8495
Mailing Address - Country:US
Mailing Address - Phone:770-495-9995
Mailing Address - Fax:770-232-1999
Practice Address - Street 1:6290 ABBOTTS BRIDGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8495
Practice Address - Country:US
Practice Address - Phone:770-495-9995
Practice Address - Fax:770-232-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6930Medicare PIN