Provider Demographics
NPI:1356410948
Name:DAVID R. LESCH, M.D., LLC
Entity type:Organization
Organization Name:DAVID R. LESCH, M.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:LESCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-814-9455
Mailing Address - Street 1:4385 JOHNS CREEK PARKWAY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6095
Mailing Address - Country:US
Mailing Address - Phone:770-814-9455
Mailing Address - Fax:678-990-5846
Practice Address - Street 1:4385 JOHNS CREEK PARKWAY
Practice Address - Street 2:SUITE 230
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6095
Practice Address - Country:US
Practice Address - Phone:770-814-9455
Practice Address - Fax:678-990-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
GA031968174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10055949OtherAMERIGROUP ID
GA914888852AMedicaid
GAGRP6446Medicare ID - Type UnspecifiedGROUP PROVIDER ID