Provider Demographics
NPI:1891866273
Name:AMATO, LESA A (DC)
Entity Type:Individual
Prefix:DR
First Name:LESA
Middle Name:A
Last Name:AMATO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 VILLAGE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6728
Mailing Address - Country:US
Mailing Address - Phone:912-882-8888
Mailing Address - Fax:912-882-8889
Practice Address - Street 1:2475 VILLAGE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6728
Practice Address - Country:US
Practice Address - Phone:912-882-8888
Practice Address - Fax:912-882-8889
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor