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Leslie A David

Family Medicine

Allopathic & Osteopathic Physicians

1315 Jesse Jewell Pkwy NE Ste 300, Gainesville, GA 30501-3822

PECOS Enrollment

This provider is enrolled in PECOS as LESLIE DAVID.

Based on the most recent information from CMS, provider Leslie A David is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1447211297
Provider Type
Individual
Full Name
David, Leslie A
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
3/31/2006
Last Updated
10/6/2020

Contact Information

Practice Location

1315 Jesse Jewell Pkwy NE Ste 300, Gainesville, GA 30501-3822

(770) 219-9445

Unlisted Fax

Mailing Location

PO Box 742616, Atlanta, GA 30374-2616

(770) 219-8420

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 60363 Georgia
Code 207QS0010X	Description Family Medicine Allopathic & Osteopathic Physicians	License 060363 Georgia

Provider Identifiers

ID	Description	Issuer
ID 574554373A	Description Medicaid	Issuer Unlisted Georgia

Leslie A David

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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