Healthcare Provider Details

I. General information

NPI: 1184104358
Provider Name (Legal Business Name): THOMAS CHARLES LOVELACE HADS,HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 HIGHWAY 515 W STE D
BLAIRSVILLE GA
30512-7830
US

IV. Provider business mailing address

411 HIGHWAY 515 W STE 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 TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000892
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: