Provider Demographics
NPI:1457433138
Name:FLEISHMAN, KENNETH EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDWIN
Last Name:FLEISHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:934 BRIARCLIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2618
Mailing Address - Country:US
Mailing Address - Phone:404-888-6028
Mailing Address - Fax:404-872-5088
Practice Address - Street 1:711 EXECUTIVE PL
Practice Address - Street 2:3RD FLOOR
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5193
Practice Address - Country:US
Practice Address - Phone:910-615-3700
Practice Address - Fax:910-615-3798
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-007562084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry