Healthcare Provider Details

I. General information

NPI: 1982960217
Provider Name (Legal Business Name): BRUCE A TOWNSEND ACA B.C.-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W BROAD ST
ATHENS GA
30606-0001
US

IV. Provider business mailing address

1650 W BROAD ST
ATHENS GA
30606-3550
US

V. Phone/Fax

Practice location:
  • Phone: 706-548-5245
  • Fax: 706-548-6533
Mailing address:
  • Phone: 706-548-5245
  • Fax: 706-548-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberHADS000593
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000593
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: