Provider Demographics
NPI:1306541933
Name:MANIMALETHU, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MANIMALETHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1004
Mailing Address - Country:US
Mailing Address - Phone:404-712-5511
Mailing Address - Fax:404-712-5895
Practice Address - Street 1:1441 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1971
Practice Address - Country:US
Practice Address - Phone:404-712-5511
Practice Address - Fax:404-712-5895
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program