Provider Demographics
NPI:1871500017
Name:LESLIE, YVETTE V (MD)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:V
Last Name:LESLIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1017 EMORY PARC PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4043
Mailing Address - Country:US
Mailing Address - Phone:770-939-7707
Mailing Address - Fax:770-939-7706
Practice Address - Street 1:5900 HILLANDALE DR
Practice Address - Street 2:STE 345
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3802
Practice Address - Country:US
Practice Address - Phone:770-939-7707
Practice Address - Fax:770-939-7706
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048947207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG95512Medicare UPIN
GA04BDCPBMedicare ID - Type Unspecified