Provider Demographics
NPI:1144242207
Name:GASKILL, LESLIE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:S
Last Name:GASKILL
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 1:6290 ABBOTTS BRIDGE RD STE 201 BLDG 200
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1750
Mailing Address - Country:US
Mailing Address - Phone:770-495-9995
Mailing Address - Fax:770-232-1999
Practice Address - Street 1:6290 ABBOTTS BRIDGE RD STE 201 BLDG 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1750
Practice Address - Country:US
Practice Address - Phone:770-495-9995
Practice Address - Fax:770-232-1999
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI24100Medicare UPIN
GA08BBRPFMedicare ID - Type UnspecifiedPROVIDER #
GAGRP6930Medicare ID - Type UnspecifiedPROVIDER GROUP #