Healthcare Provider Details

I. General information

NPI: 1720631047
Provider Name (Legal Business Name): GREATER ATLANTA HEARING P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 PEACHTREE PKWY STE 106
CUMMING GA
30041-7401
US

IV. Provider business mailing address

564 PEACHTREE PKWY STE 106
CUMMING GA
30041-7401
US

V. Phone/Fax

Practice location:
  • Phone: 678-771-8857
  • Fax: 678-771-8862
Mailing address:
  • Phone: 678-771-8857
  • Fax: 678-771-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN KENNETH JONES
Title or Position: PRESIDENT
Credential: M.ED
Phone: 678-771-8857