Provider Demographics
NPI:1720277056
Name:CONLEY, LAKEISHA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKEISHA
Middle Name:MARIE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 GOODMAN RD
Mailing Address - Street 2:STE 4-326
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7333
Mailing Address - Country:US
Mailing Address - Phone:662-822-7454
Mailing Address - Fax:866-353-7575
Practice Address - Street 1:1282 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3414
Practice Address - Country:US
Practice Address - Phone:662-822-7454
Practice Address - Fax:866-353-7575
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00325207R00000X, 208M00000X
TN59916207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR9474Medicare PIN