Individual
LESLIE A. JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2550 WINDY HILL RD SE, SUITE 302, MARIETTA, GA 30067-8665
(678) 574-0943
(678) 574-0943
Mailing address
3155 N POINT PKWY, ATTN: CREDENTIALING DEPT, BUILDING F, SUITE 100, ALPHARETTA, GA 30005
(770) 645-9181
(770) 645-8455
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN081312
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000558346H
—
GA
05
—
000558346I
—
GA
05
—
000558346J
—
GA
05
—
000558346K
—
GA
05
—
000558346L
—
GA
05
—
000558346M
—
GA
05
—
000558346N
—
GA
05
—
000558346O
—
GA
Enumeration date
10/05/2005
Last updated
12/23/2008
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