Healthcare Provider Details

I. General information

NPI: 1548520752
Provider Name (Legal Business Name): VITAL SOUNDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BLUEWATER CT
COLLEGE PARK GA
30349-3065
US

IV. Provider business mailing address

220 BLUEWATER CT
COLLEGE PARK GA
30349-3065
US

V. Phone/Fax

Practice location:
  • Phone: 678-637-1265
  • Fax: 404-766-6314
Mailing address:
  • Phone: 678-637-1265
  • Fax: 404-766-6314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003645
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAUD003645
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberAUD003645
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD003645
License Number StateGA

VIII. Authorized Official

Name: TIFFANY HANEY
Title or Position: AUDIOLOGIST
Credential: AUD
Phone: 678-637-1265