Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 207V00000X | GA |
NPI | 1154324853 |
---|---|
Provider Name | Mrs. Leslie Kyrin Dunston |
First Address | Atlanta, GA 30342-4740 |
Second Address | Atlanta, GA 30342-4740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 09/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00705977B | (05) | GA |
00804856A | (05) | GA |
G29690 | (02) | GA |