Basic Information
| Provider Information | |||||||||
| NPI: | 1629697826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENNINGTON | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | JONES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5505 PEACHTREE DUNWOODY RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045611924 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5505 PEACHTREE DUNWOODY RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 04/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | RN069507 | GA | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.