Healthcare Provider Details

I. General information

NPI: 1902261274
Provider Name (Legal Business Name): COMPLETE HEALTH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4153 FLAT SHOALS PKWY BLDG A STE 104
DECATUR GA
30034-4106
US

IV. Provider business mailing address

11770 HAYNES BRIDGE RD STE 205-215
ALPHARETTA GA
30009-1966
US

V. Phone/Fax

Practice location:
  • Phone: 404-241-7062
  • Fax: 404-243-0357
Mailing address:
  • Phone: 404-241-7062
  • Fax: 404-243-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number074690
License Number StateGA

VIII. Authorized Official

Name: DR. VICTOR Y LESLIE
Title or Position: OWNER
Credential: MD
Phone: 404-241-7062