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General NPI Number Information
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NPI Number | 1598940629
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Entity Type | Individual
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Provider Name | LEESHELL ALEXANDER C.N.A
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Gender | Female
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 2496 EMMA WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2719
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Country | US
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Telephone | 404-447-3989
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Fax |
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Provider Business Mailing Address
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Address Line | 2496 EMMA WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2719
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Country | US
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Telephone | 404-447-3989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CNOOOOOO2924
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License Number State | GA
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