Provider Demographics
NPI:1902053218
Name:BURKE, LEIGH ANN ELMGREN (BC - HIS)
Entity Type:Individual
Prefix:
First Name:LEIGH ANN
Middle Name:ELMGREN
Last Name:BURKE
Suffix:
Gender:F
Credentials:BC - HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 FREDERICK STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-351-3038
Mailing Address - Fax:912-351-4674
Practice Address - Street 1:5203 FREDERICK STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-351-3038
Practice Address - Fax:912-351-4674
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000700237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3593OtherMEDICARE GRP #
GA582468197Medicaid