Provider Demographics
NPI:1518516228
Name:BURLISON, EMELI ELEYN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:EMELI
Middle Name:ELEYN
Last Name:BURLISON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SENTRY OAK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1200
Mailing Address - Country:US
Mailing Address - Phone:478-365-0184
Mailing Address - Fax:
Practice Address - Street 1:428 SENTRY OAK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028-1200
Practice Address - Country:US
Practice Address - Phone:478-365-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH043518124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist