Provider Demographics
NPI:1841216199
Name:NOVAK, LESLIE SHEMAIN (MPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SHEMAIN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-541-5492
Mailing Address - Fax:
Practice Address - Street 1:3007 PANOLA RD STE C
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2492
Practice Address - Country:US
Practice Address - Phone:770-987-1122
Practice Address - Fax:770-987-1149
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03783225100000X
GAPT007778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBDRHMedicare ID - Type Unspecified
GAGRP4895Medicare ID - Type UnspecifiedGROUP NUMBER