Individual
MRS. LESLIE JEAN OGILVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1524 LAFAYETTE PKWY, LAGRANGE, GA 30241-2566
(706) 530-2151
(770) 460-6610
Mailing address
1524 LAFAYETTE PKWY, LAGRANGE, GA 30241-2566
(706) 530-2151
(770) 460-6610
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
PA.0004937
CO
363A00000X
Physician Assistant
Primary
9261
GA
363A00000X
Physician Assistant
PA.0004937
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000158036
—
CO
01
—
PA.0004937
MEDICAL LICENSE
CO
Enumeration date
07/08/2010
Last updated
03/07/2023
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