Healthcare Provider Details

I. General information

NPI: 1902950462
Provider Name (Legal Business Name): LEISHA HARRELL ESPY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E GORDON AVE
ROSSVILLE GA
30741-1318
US

IV. Provider business mailing address

100 E GORDON AVE
ROSSVILLE GA
30741-1318
US

V. Phone/Fax

Practice location:
  • Phone: 706-866-7557
  • Fax: 706-858-6328
Mailing address:
  • Phone: 706-866-7557
  • Fax: 706-858-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2728
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: