MEDICARE: ANTHONY LESSA MD

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	208D00000X	General Practice Physician	26315	AL

General Provider Information

NPI Number	:	1396043881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY LESSA MD

Provider Business Mailing Address
First Line	:	210 NORTH ST W
Second Line	:
City	:	TALLADEGA
State	:	AL
Zip	:	35160-2083
Country	:	US
Telephone Number	:	256-362-0066
Fax Number	:	256-362-6700

Provider Business Practice Location Address
First Line	:	210 NORTH ST W
Second Line	:
City	:	TALLADEGA
State	:	AL
Zip	:	35160-2083
Country	:	US
Telephone Number	:	256-362-0066
Fax Number	:	256-362-6700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2011
Last Update Date	:	04/15/2016

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