Individual
SAMANTHA LEYSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 PERRY HOUSE RD, FITZGERALD, GA 31750-8857
(229) 424-7104
(229) 424-7122
Mailing address
200 PERRY HOUSE RD, P O BOX 1447, FITZGERALD, GA 31750-8857
(229) 424-7104
(229) 424-7122
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PCET002247
GA
Other
Enumeration date
03/28/2016
Last updated
03/28/2016
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