Provider Demographics
NPI:1467997726
Name:SMITH, LESLIE (NP-BC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ALSTON ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31825-1404
Mailing Address - Country:US
Mailing Address - Phone:229-887-3324
Mailing Address - Fax:229-887-2559
Practice Address - Street 1:220 ALSTON ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:GA
Practice Address - Zip Code:31825-1404
Practice Address - Country:US
Practice Address - Phone:229-887-3324
Practice Address - Fax:229-887-2559
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN157950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily