Healthcare Provider Details

I. General information

NPI: 1023935053
Provider Name (Legal Business Name): LEISHA HANCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PELHAM RD N
JACKSONVILLE AL
36265-1602
US

IV. Provider business mailing address

175 COUNTY ROAD 411
FYFFE AL
35971-4134
US

V. Phone/Fax

Practice location:
  • Phone: 256-601-0673
  • Fax:
Mailing address:
  • Phone: 256-601-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: