Healthcare Provider Details

I. General information

NPI: 1023460532
Provider Name (Legal Business Name): LESLIE HILL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6976 OLD CUSSETA RD BLDG 4202
FORT BENNING GA
31905-5431
US

IV. Provider business mailing address

6976 OLD CUSSETA RD BLDG 4202
FORT BENNING GA
31905-5431
US

V. Phone/Fax

Practice location:
  • Phone: 706-545-5228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH007428
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: