Provider Demographics
NPI:1992578132
Name:LEDBETTER, KRISTIN LEE (CSFA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:CSFA
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Mailing Address - Street 1:3620 LAVILLA DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-1113
Mailing Address - Country:US
Mailing Address - Phone:404-916-6374
Mailing Address - Fax:
Practice Address - Street 1:2537 CEDARCREST RD STE 305-14
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8900
Practice Address - Country:US
Practice Address - Phone:470-336-8190
Practice Address - Fax:770-336-6620
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2024-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
100106339363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical