Provider Demographics
NPI:1679329635
Name:BURNSIDE, ALAINA MARIE
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:MARIE
Last Name:BURNSIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 LEGRAND CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8189
Mailing Address - Country:US
Mailing Address - Phone:678-983-2423
Mailing Address - Fax:
Practice Address - Street 1:1000 EISENHOWER DR STE H
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2601
Practice Address - Country:US
Practice Address - Phone:912-335-1650
Practice Address - Fax:912-335-2377
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist