Healthcare Provider Details

I. General information

NPI: 1922131705
Provider Name (Legal Business Name): SKYLER PERKINS JOSEPH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SKYLER PERKINS AUD

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 THORN CREEK WAY
DALLAS GA
30157-9623
US

IV. Provider business mailing address

84 THORN CREEK WAY
DALLAS GA
30157-9623
US

V. Phone/Fax

Practice location:
  • Phone: 706-631-2893
  • Fax:
Mailing address:
  • Phone: 706-631-2893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number15131
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003890
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: