Provider Demographics
NPI:1780004184
Name:PEREZ, LESLIE ISABEL (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ISABEL
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1138
Mailing Address - Country:US
Mailing Address - Phone:404-929-8824
Mailing Address - Fax:
Practice Address - Street 1:48 MAIN ST STE 3A
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-1895
Practice Address - Country:US
Practice Address - Phone:678-723-0400
Practice Address - Fax:770-599-9779
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106164207Q00000X
390200000X
GA84321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program