MEDICARE: DR. LEESHA MICHELLE ELLIS-COX MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD.29736	AL
2	2084P0804X	Child & Adolescent Psychiatry Physician	54613	GA

General Provider Information

NPI Number	:	1598764698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEESHA MICHELLE ELLIS-COX MD, MPH

Provider Business Mailing Address
First Line	:	1701 AVENUE D, ENSLEY
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35218
Country	:	US
Telephone Number	:	205-788-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 AVENUE D
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35218-1532
Country	:	US
Telephone Number	:	205-788-7770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/16/2016

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