Provider Demographics
NPI:1033267364
Name:BILES, LEZLIE F (MD)
Entity Type:Individual
Prefix:
First Name:LEZLIE
Middle Name:F
Last Name:BILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 SYLVAN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-1548
Mailing Address - Country:US
Mailing Address - Phone:770-775-4540
Mailing Address - Fax:770-775-4078
Practice Address - Street 1:146 SYLVAN DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1548
Practice Address - Country:US
Practice Address - Phone:770-775-4540
Practice Address - Fax:770-775-4078
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052893208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA894425821CMedicaid