Provider Demographics
NPI:1083673255
Name:PACE, LESLYE HOWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLYE
Middle Name:HOWELL
Last Name:PACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLYE
Other - Middle Name:HOWELL
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 740209
Mailing Address - Street 2:DEPT. 1029
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0209
Mailing Address - Country:US
Mailing Address - Phone:941-360-1566
Mailing Address - Fax:941-358-9818
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:SUITE 506
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-299-1679
Practice Address - Fax:404-508-7558
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057123207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1319586161Medicaid
GA1319586161Medicaid
GA05BDKXDMedicare ID - Type Unspecified