Healthcare Provider Details

I. General information

NPI: 1265807358
Provider Name (Legal Business Name): MOBILE HEARING OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SCOTT RD
AUGUSTA GA
30906-2539
US

IV. Provider business mailing address

12910 SHELBYVILLE RD SUITE 300
LOUISVILLE KY
40243-1593
US

V. Phone/Fax

Practice location:
  • Phone: 706-793-1057
  • Fax:
Mailing address:
  • Phone: 502-244-2441
  • Fax: 502-254-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: JASON P WIGAND
Title or Position: OWNER
Credential: AUD
Phone: 855-259-9183