Provider Demographics
NPI:1023370905
Name:PICKELL, LESLEY B (MD)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:B
Last Name:PICKELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:B
Other - Last Name:BUNDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25039
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0039
Mailing Address - Country:US
Mailing Address - Phone:864-382-4000
Mailing Address - Fax:864-382-4040
Practice Address - Street 1:213 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3509
Practice Address - Country:US
Practice Address - Phone:864-382-4000
Practice Address - Fax:864-382-4040
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL34888207V00000X
SC34888207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology