Provider Demographics
NPI:1710228127
Name:MILLER BURNFIN, KRISTIAN LEIGHANN (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:LEIGHANN
Last Name:MILLER BURNFIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4802
Mailing Address - Country:US
Mailing Address - Phone:229-214-2663
Mailing Address - Fax:229-888-7590
Practice Address - Street 1:604 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4802
Practice Address - Country:US
Practice Address - Phone:229-214-2663
Practice Address - Fax:229-888-7590
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT008611173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist