Healthcare Provider Details

I. General information

NPI: 1689860595
Provider Name (Legal Business Name): MRAZ AUDIOLOGY CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400C OLD MILTON PKWY STE 385
ALPHARETTA GA
30005-4438
US

IV. Provider business mailing address

3400 OLD MILTON PKWY BLDG C, SUITE 385
ALPHARETTA GA
30005
US

V. Phone/Fax

Practice location:
  • Phone: 770-653-7027
  • Fax: 678-824-8218
Mailing address:
  • Phone: 770-653-7027
  • Fax: 678-824-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003473
License Number StateGA

VIII. Authorized Official

Name: DR. NORMA R MRAZ
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 770-653-7027