Provider Demographics
NPI:1447040092
Name:LESESNE, JUANITA M J
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:M J
Last Name:LESESNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 TREEHILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3098
Mailing Address - Country:US
Mailing Address - Phone:770-981-7709
Mailing Address - Fax:770-981-7709
Practice Address - Street 1:5905 TREEHILLS PKWY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3098
Practice Address - Country:US
Practice Address - Phone:770-981-7709
Practice Address - Fax:770-981-7709
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator