Active NPI
Samantha Leyse
- Speech-Language Pathologist
- Fitzgerald, GA
National Provider Identifier
1356703391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- PCET002247
- Practice address
- 200 Perry House Rd
Fitzgerald, GA 31750-8857 - Phone
- (229) 424-7104
- Fax
- (229) 424-7122
- NPI assigned
- Mar 28, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | PCET002247 | GA | Primary |
Addresses
Primary practice location
200 Perry House Rd
Fitzgerald, GA 31750-8857
Mailing address
200 Perry House Rd
P O Box 1447
Fitzgerald, GA 31750-8857
Phone (229) 424-7104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCET002247 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459123200000",
"number": "1356703391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 PERRY HOUSE RD",
"address_2": "P O BOX 1447",
"city": "FITZGERALD",
"state": "GA",
"postal_code": "317508857",
"telephone_number": "229-424-7104",
"fax_number": "229-424-7122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 PERRY HOUSE RD",
"city": "FITZGERALD",
"state": "GA",
"postal_code": "317508857",
"telephone_number": "229-424-7104",
"fax_number": "229-424-7122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEYSE",
"first_name": "SAMANTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-28",
"last_updated": "2016-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "PCET002247",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fitzgerald, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.