Healthcare Provider Details

I. General information

NPI: 1912042136
Provider Name (Legal Business Name): SOUTHEASTERN HEARING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/24/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 ATLANTIC BLVD UNIT 113
JACKSONVILLE FL
32225-5822
US

IV. Provider business mailing address

4006 3RD ST S
JACKSONVILLE BEACH FL
32250
US

V. Phone/Fax

Practice location:
  • Phone: 904-220-3277
  • Fax:
Mailing address:
  • Phone: 904-247-4327
  • Fax: 904-247-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. TROY C MAHAN
Title or Position: PRESIDENT
Credential: HIS-BC
Phone: 904-247-4327