MEDICARE: MYLEE ANN LANSDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	HAA000163	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	237700000X	OTHER	GA	1134669740

General Provider Information

NPI Number	:	1063906840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLEE ANN LANSDON

Provider Business Mailing Address
First Line	:	6783 VETERANS PKWY STE 300
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3284
Country	:	US
Telephone Number	:	706-576-9888
Fax Number	:	706-576-9928

Provider Business Practice Location Address
First Line	:	6783 VETERANS PKWY STE 300
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3284
Country	:	US
Telephone Number	:	706-576-9888
Fax Number	:	706-576-9928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	06/15/2018

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Directions to “ MYLEE ANN LANSDON ” Practice Location

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