Basic Information
Provider Information
NPI: 1285972943
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARNER
FirstName: LESLIE
MiddleName: I
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1076
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305031076
CountryCode: US
TelephoneNumber: 7705327179
FaxNumber: 7705341312
Practice Location
Address1: 743 SPRING ST NE
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305013715
CountryCode: US
TelephoneNumber: 7705327179
FaxNumber: 7705341312
Other Information
ProviderEnumerationDate: 01/30/2013
LastUpdateDate: 01/30/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN176178GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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