Healthcare Provider Details

I. General information

NPI: 1033267364
Provider Name (Legal Business Name): LEZLIE F BILES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 SYLVAN DR
JACKSON GA
30233-1548
US

IV. Provider business mailing address

146 SYLVAN DR
JACKSON GA
30233-1548
US

V. Phone/Fax

Practice location:
  • Phone: 770-775-4540
  • Fax: 770-775-4078
Mailing address:
  • Phone: 770-775-4540
  • Fax: 770-775-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number052893
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: