Healthcare Provider Details

I. General information

NPI: 1912942301
Provider Name (Legal Business Name): AUDIOLOGICAL CONSULTANTS OF ATLANTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6018 SANDY SPRINGS CIR NE
ATLANTA GA
30328-3832
US

IV. Provider business mailing address

6018 SANDY SPRINGS CIR NE
SANDY SPRINGS GA
30328-3832
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-5194
  • Fax: 404-256-5151
Mailing address:
  • Phone: 404-256-5194
  • Fax: 404-256-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: KADYN WILLIAMS
Title or Position: CO-DIRECTOR
Credential:
Phone: 404-256-5194