Provider Demographics
NPI:1316326523
Name:JARRETT, LESLIE DIANE (NP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:DIANE
Last Name:JARRETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 CHAMPIONS WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8544
Mailing Address - Country:US
Mailing Address - Phone:404-272-0698
Mailing Address - Fax:
Practice Address - Street 1:2978 HIGHWAY 36 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-6150
Practice Address - Country:US
Practice Address - Phone:770-504-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN090996364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health