Provider Demographics
NPI:1790565661
Name:REYNOLDS, LEKESHA LESHELL (ST)
Entity Type:Individual
Prefix:
First Name:LEKESHA
Middle Name:LESHELL
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 TRAMMELL RD APT 159
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1352
Mailing Address - Country:US
Mailing Address - Phone:678-687-2374
Mailing Address - Fax:
Practice Address - Street 1:6001 TRAMMELL RD APT 159
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1352
Practice Address - Country:US
Practice Address - Phone:678-687-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor