Provider Demographics
NPI:1477654390
Name:NORMAN, LESLIE CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:CAROL
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1830 INDEPENDENCE SQ
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5165
Mailing Address - Country:US
Mailing Address - Phone:770-454-8114
Mailing Address - Fax:770-454-8597
Practice Address - Street 1:1830 INDEPENDENCE SQ
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5165
Practice Address - Country:US
Practice Address - Phone:770-454-8114
Practice Address - Fax:770-454-8597
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-11-17
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Provider Licenses
StateLicense IDTaxonomies
GA026608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40768Medicare UPIN