Individual
MRS. LESLIE G CORNELISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1449 W CHURCH ST, JASPER, GA 30143-4075
(706) 692-2709
(706) 692-8986
Mailing address
96 SUMMIT ST, JASPER, GA 30143-1420
(706) 692-7698
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12612
GA
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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