Healthcare Provider Details

I. General information

NPI: 1326205824
Provider Name (Legal Business Name): LESLIE J CAUDILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE NEELY MD

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 WESTGATE CIR
BRENTWOOD TN
37027-8019
US

IV. Provider business mailing address

222 22ND AVE N
NASHVILLE TN
37203-1852
US

V. Phone/Fax

Practice location:
  • Phone: 629-255-2080
  • Fax: 629-255-4153
Mailing address:
  • Phone: 629-255-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number49471
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: