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General NPI Number Information
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NPI Number | 1790761039
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Entity Type | Individual
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Provider Name | ASHLEY GRACE LESLEY M.D
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Gender | Female
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 5 STEVENS ST STE 100
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City | GREENVILLE
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State | SC
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Zip | 29605-4528
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Country | US
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Telephone | 864-250-6487
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Fax | 864-250-6475
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Provider Business Mailing Address
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Address Line | 601 HALTON RD
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City | GREENVILLE
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State | SC
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Zip | 29607-3403
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Country | US
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Telephone | 864-458-7956
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Fax | 864-458-8390
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A102813
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D0073579
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 01058160A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | 51973
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License Number State | SC
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