Provider Demographics
NPI:1457618936
Name:HARDISON, LESLIE K (RN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:K
Last Name:HARDISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5548
Mailing Address - Country:US
Mailing Address - Phone:770-452-0017
Mailing Address - Fax:770-452-0791
Practice Address - Street 1:6330 PRIMROSE HILL CT
Practice Address - Street 2:SUITE 207
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4544
Practice Address - Country:US
Practice Address - Phone:770-452-0017
Practice Address - Fax:770-452-0791
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN044703163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse