Provider Demographics
NPI:1699044529
Name:DOWLING, LESLIE BENNETT (DPM)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BENNETT
Last Name:DOWLING
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3354
Mailing Address - Country:US
Mailing Address - Phone:912-490-3668
Mailing Address - Fax:912-490-5577
Practice Address - Street 1:545 KNIGHT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3354
Practice Address - Country:US
Practice Address - Phone:912-490-3668
Practice Address - Fax:912-490-5577
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001151213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126292BMedicaid
GA6713070001Medicare NSC
GA202I489897Medicare PIN