Healthcare Provider Details

I. General information

NPI: 1255252516
Provider Name (Legal Business Name): LEIGH ANN COMBASS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 37
STATENVILLE GA
31648-0037
US

IV. Provider business mailing address

PO BOX 37
STATENVILLE GA
31648-0037
US

V. Phone/Fax

Practice location:
  • Phone: 229-559-5103
  • Fax: 229-559-7256
Mailing address:
  • Phone: 229-559-5103
  • Fax: 229-559-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN185310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: