Provider Demographics
NPI:1154324853
Name:DUNSTON, LESLIE KYRIN (MD, FACOG)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:KYRIN
Last Name:DUNSTON
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 GLENRIDGE CONNECTOR STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4740
Mailing Address - Country:US
Mailing Address - Phone:678-744-6862
Mailing Address - Fax:
Practice Address - Street 1:5555 GLENRIDGE CONNECTOR STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4740
Practice Address - Country:US
Practice Address - Phone:678-744-6862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207V00000X207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00705977BMedicaid
GA00804856AMedicaid
GA16BDFWJMedicare ID - Type Unspecified
GAG29690Medicare UPIN
GAGRP3669Medicare ID - Type Unspecified