Provider Demographics
NPI:1588299879
Name:GALLEMORE, LETICIA L
Entity type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:L
Last Name:GALLEMORE
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 1:400 WEST PEACHTREE STREET NW
Mailing Address - Street 2:SUITE #4 1240
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:407-680-7181
Mailing Address - Fax:
Practice Address - Street 1:45 E LAWN WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-6824
Practice Address - Country:US
Practice Address - Phone:407-680-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2023-12-19
Deactivation Date:2020-05-15
Deactivation Code:
Reactivation Date:2023-12-19
Provider Licenses
StateLicense IDTaxonomies
GACN0000104039374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide