Provider Demographics
NPI:1982682662
Name:LESESNE, JOSEPH B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:B
Last Name:LESESNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:188 PEACHTREE WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3738
Mailing Address - Country:US
Mailing Address - Phone:404-326-7184
Mailing Address - Fax:678-288-9556
Practice Address - Street 1:101 RIVERSTONE VIS STE 102
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6630
Practice Address - Country:US
Practice Address - Phone:706-258-4140
Practice Address - Fax:706-258-4141
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2020-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA029712207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I832072OtherMEDICARE PTAN
GA83BBBNDMedicare PIN
GAD70539Medicare UPIN