Individual
LESLIE DOUGLAS-CHURCHWELL
Active
Individual
LESLIE DOUGLAS-CHURCHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
55309
CT
207R00000X
Internal Medicine Physician
TN25944
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110103872
RR MEDICARE
TN
01
—
3005101
BLUE CROSS BLUE SHIELD
TN
05
—
3085941
—
TN
01
—
4509232
AETNA
TN
Enumeration date
05/09/2007
Last updated
07/29/2016
Update your record
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