Healthcare Provider Details

I. General information

NPI: 1619891520
Provider Name (Legal Business Name): NORTHLAND HEARING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STEVEN B TANGER BLVD
COMMERCE GA
30529-3574
US

IV. Provider business mailing address

6700 WASHINGTON AVE S STE 1B
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 706-335-4630
  • Fax:
Mailing address:
  • Phone: 800-769-2590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: RENEE CATHERINE BERTRAM
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 800-328-8602