Provider Demographics
NPI:1184054900
Name:HERRON, LESIA
Entity type:Individual
Prefix:
First Name:LESIA
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESIA
Other - Middle Name:
Other - Last Name:HERRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2020 HOWELL MILL RD NW, D-421
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1732
Mailing Address - Country:US
Mailing Address - Phone:804-651-0000
Mailing Address - Fax:
Practice Address - Street 1:3408 NOBLE CREEK NWDR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-5121
Practice Address - Country:US
Practice Address - Phone:804-651-0000
Practice Address - Fax:410-569-7137
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1020457163W00000X
GARN115103363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse