Healthcare Provider Details

I. General information

NPI: 1699044529
Provider Name (Legal Business Name): LESLIE BENNETT DOWLING DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 KNIGHT AVE
WAYCROSS GA
31501-3354
US

IV. Provider business mailing address

545 KNIGHT AVE
WAYCROSS GA
31501-3354
US

V. Phone/Fax

Practice location:
  • Phone: 912-490-3668
  • Fax: 912-490-5577
Mailing address:
  • Phone: 912-490-3668
  • Fax: 912-490-5577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001151
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: