Healthcare Provider Details

I. General information

NPI: 1346781135
Provider Name (Legal Business Name): KASI AMANDA RUNION H.I.S. - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W WAUGH ST
DALTON GA
30720-8769
US

IV. Provider business mailing address

3644 PEAVINE RD
CROSSVILLE TN
38571-7923
US

V. Phone/Fax

Practice location:
  • Phone: 706-271-0999
  • Fax: 706-271-0992
Mailing address:
  • Phone: 931-709-0661
  • Fax: 931-709-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000945
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: