Healthcare Provider Details

I. General information

NPI: 1457433138
Provider Name (Legal Business Name): KENNETH EDWIN FLEISHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 EXECUTIVE PL 3RD FLOOR
FAYETTEVILLE NC
28305-5193
US

IV. Provider business mailing address

934 BRIARCLIFF RD NE
ATLANTA GA
30306-2618
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3700
  • Fax: 910-615-3798
Mailing address:
  • Phone: 404-888-6028
  • Fax: 404-872-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2014-00756
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2014-00756
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: