Provider Demographics
NPI:1063064350
Name:MEDLIN (BELTZ), LEAH A (HEARING AID DISPENSE)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:A
Last Name:MEDLIN (BELTZ)
Suffix:
Gender:F
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 LOVEJOY ST SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-2620
Mailing Address - Country:US
Mailing Address - Phone:770-771-2659
Mailing Address - Fax:
Practice Address - Street 1:999 WHITLOCK AVE SW STE 8
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1995
Practice Address - Country:US
Practice Address - Phone:770-422-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5000997237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist