MEDICARE: FAMILY HEARING AND SPEECH CENTER OF WEST COBB, INC.

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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1790782498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEARING AND SPEECH CENTER OF WEST COBB, INC.

Provider Business Mailing Address
First Line	:	260 WHISPERWOOD LN NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-1665
Country	:	US
Telephone Number	:	770-499-8782
Fax Number	:

Provider Business Practice Location Address
First Line	:	1690 POWDER SPRINGS RD SW
Second Line	:	SUITE 208
City	:	MARIETTA
State	:	GA
Zip	:	30064-4844
Country	:	US
Telephone Number	:	770-425-1095
Fax Number	:	770-425-4330

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DONNA LEACH
Credential	:	AU.D.
Telephone Number	:	770-425-1095

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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