Healthcare Provider Details

I. General information

NPI: 1386247286
Provider Name (Legal Business Name): GEORGIA HEARING AID FACTORY OUTLET, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 ATLANTA HWY # 61
ATHENS GA
30606-7201
US

IV. Provider business mailing address

800 HIGHWAY 400 S STE 525
DAWSONVILLE GA
30534-6894
US

V. Phone/Fax

Practice location:
  • Phone: 706-888-6921
  • Fax:
Mailing address:
  • Phone: 770-868-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY MICHELE BUMGARNER
Title or Position: HIS
Credential:
Phone: 770-868-6036