Provider Demographics
NPI:1861488629
Name:POPE, LESLIE A (DO)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:POPE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6929
Mailing Address - Country:US
Mailing Address - Phone:770-396-2496
Mailing Address - Fax:770-493-6189
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:SUITE 412
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-396-2496
Practice Address - Fax:770-493-6189
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-05-29
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Provider Licenses
StateLicense IDTaxonomies
GA024855207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00291068BMedicaid
GA00291068BMedicaid
GA16BDGHMMedicare PIN
GA160036264Medicare PIN