Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 08771 | GA |
NPI | 1811523574 |
---|---|
Provider Name | Denise M Leslie-Willams |
First Address | Atlanta, GA 30328-3861 |
Second Address | Atlanta, GA 30328-3861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2020 |
Last Update Date | 13/03/2020 |