Provider Demographics
NPI:1295266658
Name:BELINDA BURROUGHS, INC.
Entity type:Organization
Organization Name:BELINDA BURROUGHS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-223-0967
Mailing Address - Street 1:800 MALLERY ST APT 78
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-4045
Mailing Address - Country:US
Mailing Address - Phone:912-223-0967
Mailing Address - Fax:912-268-2204
Practice Address - Street 1:800 MALLERY ST APT 78
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4045
Practice Address - Country:US
Practice Address - Phone:912-223-0967
Practice Address - Fax:912-268-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP 005622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA155808701Medicaid