Individual
LESLIE INEZ TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCT
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(770) 339-2359
Mailing address
5603 ROCK SPRINGS RD, LITHONIA, GA 30038-1130
(404) 452-7619
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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