Provider Demographics
NPI:1205946050
Name:KIRKLAND, LEA HARRELL (MD)
Entity type:Individual
Prefix:MRS
First Name:LEA
Middle Name:HARRELL
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2990 BETHESDA PLACE
Mailing Address - Street 2:SUITE 601-A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-774-1755
Mailing Address - Fax:336-774-1140
Practice Address - Street 1:2990 BETHESDA PLACE
Practice Address - Street 2:SUITE 601-A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-774-1755
Practice Address - Fax:336-774-1140
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC327482084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
41075BMedicare UPIN