Healthcare Provider Details

I. General information

NPI: 1114222585
Provider Name (Legal Business Name): DEBRA D SPAULDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 HWY. 515 SUITE D
BLAIRSVILLE GA
30512-7830
US

IV. Provider business mailing address

411 HWY. 515 SUITE D
BLAIRSVILLE GA
30512-7830
US

V. Phone/Fax

Practice location:
  • Phone: 706-745-0091
  • Fax: 706-745-0099
Mailing address:
  • Phone: 706-745-0091
  • Fax: 706-745-0099

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 Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS00836
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: