Healthcare Provider Details

I. General information

NPI: 1336178037
Provider Name (Legal Business Name): LESLIE P. SCHILLING R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 GERMANTOWN BEND CV SUITE 101
CORDOVA TN
38018-4267
US

IV. Provider business mailing address

310 GERMANTOWN BEND CV SUITE 101
CORDOVA TN
38018-4267
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-9337
  • Fax: 901-759-7967
Mailing address:
  • Phone: 901-759-9337
  • Fax: 901-759-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN0000001271
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: