MEDICARE: LEILA L. HARTLEY, PH.D. & ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP003516	GA

General Provider Information

NPI Number	:	1164629564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEILA L. HARTLEY, PH.D. & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 19037
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31126-1037
Country	:	US
Telephone Number	:	404-812-9875
Fax Number	:	404-812-1979

Provider Business Practice Location Address
First Line	:	245 W WIEUCA RD NE
Second Line	:	SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30342-3321
Country	:	US
Telephone Number	:	404-812-9875
Fax Number	:	404-812-1979

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEILA L. HARTLEY
Credential	:	PH.D.
Telephone Number	:	404-812-9875

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	11/08/2007

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