Active NPI
Burke Lee Ellzey Jr., DMD
- Dentist
- Hattiesburg, MS
National Provider Identifier
1992313951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4136-20
- Practice address
- 949 Broadway Dr
Hattiesburg, MS 39401-7534 - Phone
- (601) 271-7300
- NPI assigned
- Jul 16, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4136-20 | MS | Primary |
Addresses
Primary practice location
949 Broadway Dr
Hattiesburg, MS 39401-7534
Mailing address
79 Quail Hollow Drive
Hattiesburg, MS 39402-8972
Phone (601) 606-4241
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 |
|---|---|---|---|
| 4136-20 | MS | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594857600000",
"number": "1992313951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 QUAIL HOLLOW DRIVE",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394028972",
"telephone_number": "601-606-4241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "949 BROADWAY DR",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394017534",
"telephone_number": "601-271-7300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLZEY",
"first_name": "BURKE",
"middle_name": "LEE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-16",
"last_updated": "2020-07-16",
"certification_date": "2020-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MS",
"license": "4136-20",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.