Provider Demographics
NPI:1598764698
Name:ELLIS-COX, LEESHA MICHELLE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LEESHA
Middle Name:MICHELLE
Last Name:ELLIS-COX
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 AVENUE D, ENSLEY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35218
Mailing Address - Country:US
Mailing Address - Phone:205-788-7770
Mailing Address - Fax:
Practice Address - Street 1:1701 AVENUE D
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-1532
Practice Address - Country:US
Practice Address - Phone:205-788-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.297362084P0800X
GA546132084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDJWZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER