Provider Demographics
NPI:1255064788
Name:GADBERRY, LESLIE B
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:B
Last Name:GADBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N 9TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-2129
Mailing Address - Country:US
Mailing Address - Phone:870-347-3398
Mailing Address - Fax:870-347-1615
Practice Address - Street 1:623 N 9TH ST STE 500
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:AR
Practice Address - Zip Code:72006-2129
Practice Address - Country:US
Practice Address - Phone:870-347-3398
Practice Address - Fax:870-347-1615
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach