Provider Demographics
NPI:1063906840
Name:LANSDON, MYLEE ANN
Entity type:Individual
Prefix:
First Name:MYLEE
Middle Name:ANN
Last Name:LANSDON
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 1:6783 VETERANS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3284
Mailing Address - Country:US
Mailing Address - Phone:706-576-9888
Mailing Address - Fax:706-576-9928
Practice Address - Street 1:6783 VETERANS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3284
Practice Address - Country:US
Practice Address - Phone:706-576-9888
Practice Address - Fax:706-576-9928
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHAA000163237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA237700000XOther1134669740