Healthcare Provider Details

I. General information

NPI: 1770043366
Provider Name (Legal Business Name): MARGARET LUMMUS HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGIE LUMMUS HAS

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 EGLIN PKWY NE
FORT WALTON BEACH FL
32548-4917
US

IV. Provider business mailing address

122 EGLIN PKWY NE
FORT WALTON BEACH FL
32548-4917
US

V. Phone/Fax

Practice location:
  • Phone: 850-243-3196
  • Fax: 850-270-5124
Mailing address:
  • Phone: 850-243-3196
  • Fax: 850-270-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: