Provider Demographics
NPI:1770843948
Name:LEIGH ANNE GRIGGS BENNETT LLC
Entity Type:Organization
Organization Name:LEIGH ANNE GRIGGS BENNETT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANICE LEIGH ANNE
Authorized Official - Middle Name:GRIGGS
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:478-290-0697
Mailing Address - Street 1:1205 BELLEVUE AVE
Mailing Address - Street 2:STE H
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4155
Mailing Address - Country:US
Mailing Address - Phone:478-290-0697
Mailing Address - Fax:
Practice Address - Street 1:1205 BELLEVUE AVE
Practice Address - Street 2:STE H
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4155
Practice Address - Country:US
Practice Address - Phone:478-290-0697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126629AMedicaid