Provider Demographics
NPI:1588271423
Name:LEFLORE, QUEENETTA JR
Entity type:Individual
Prefix:MS
First Name:QUEENETTA
Middle Name:
Last Name:LEFLORE
Suffix:JR
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 1:1475 SAND BAY DR SW APT 3007
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8989
Mailing Address - Country:US
Mailing Address - Phone:571-235-9967
Mailing Address - Fax:
Practice Address - Street 1:1475 SAND BAY DR SW APT 3007
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8989
Practice Address - Country:US
Practice Address - Phone:571-235-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012960225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist