Provider Demographics
NPI:1598892226
Name:LESLIE, LEIGH ANN (DPH)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:LESLIE
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-0125
Mailing Address - Country:US
Mailing Address - Phone:865-717-7085
Mailing Address - Fax:865-717-7146
Practice Address - Street 1:1000 LADD LANDING BLVD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2366
Practice Address - Country:US
Practice Address - Phone:865-717-7085
Practice Address - Fax:865-717-7146
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist