Individual
LESLIE SHANNON ONEILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
318 WEST PIKE STREET, SUITE 104, LAWRENCEVILLE, GA 30045
(678) 377-2833
Mailing address
525 OVERBROOK DR., ATLANTA, GA 30318
(404) 788-7416
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT005241
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00838362A
—
GA
01
—
10037601
AMERIGROUP- AAKTS
GA
01
—
307923
WELLCARE- AAKTS
GA
Enumeration date
11/27/2006
Last updated
07/09/2007
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