Provider Demographics
NPI:1053502666
Name:LITTLE, LESLEY A (PA)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:A
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 PHARR RD NE
Mailing Address - Street 2:UNIT 1811
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2464
Mailing Address - Country:US
Mailing Address - Phone:404-712-8961
Mailing Address - Fax:404-712-0569
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-712-8961
Practice Address - Fax:404-712-0569
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2372363A00000X
GA6060363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00668857OtherRR MEDICARE
MA0002642Medicare PIN