Provider Demographics
NPI:1861578858
Name:LESLIE, GAIL RUTH (CPNP)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:RUTH
Last Name:LESLIE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 BLACKMON RD
Mailing Address - Street 2:APT 4104
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4489
Mailing Address - Country:US
Mailing Address - Phone:706-562-0783
Mailing Address - Fax:
Practice Address - Street 1:7956 MARTIN LOOP
Practice Address - Street 2:
Practice Address - City:FT. BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5273
Practice Address - Country:US
Practice Address - Phone:706-544-1939
Practice Address - Fax:706-544-3950
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN072138363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD000Medicare UPIN