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NPI Code Detail

MEDICARE: MR. LESLIE ANDREW CORNETT LPN

MEDICARE: MR. LESLIE ANDREW CORNETT LPN
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
1164W00000XLicensed Practical NurseLPN052496GA

General Provider Information

NPI Number : 1568613628
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LESLIE ANDREW CORNETT LPN
Provider Business Mailing Address
First Line : 5175 ROCK PLACE DR
Second Line :
City : STONE MOUNTAIN
State : GA
Zip : 30087-4272
Country : US
Telephone Number : 770-413-3786
Fax Number :
Provider Business Practice Location Address
First Line : 2201 MOUNT ZION PKWY
Second Line :
City : MORROW
State : GA
Zip : 30260-3312
Country : US
Telephone Number : 404-785-8719
Fax Number : 404-785-8730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2008
Last Update Date : 10/08/2008

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