Healthcare Provider Details

I. General information

NPI: 1275497075
Provider Name (Legal Business Name): LAUREN CHANEY HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GLEN EAGLE CT STE 10B
CARROLLTON GA
30117-4224
US

IV. Provider business mailing address

200 GLEN EAGLE CT STE 10B
CARROLLTON GA
30117-4224
US

V. Phone/Fax

Practice location:
  • Phone: 678-796-0060
  • Fax: 470-373-2230
Mailing address:
  • Phone: 678-796-0060
  • Fax: 470-373-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS001143
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number4239
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: