Healthcare Provider Details

I. General information

NPI: 1013301415
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 CHAPEL HILL RD SUITE 145
DOUGLASVILLE GA
30135-7142
US

IV. Provider business mailing address

1001 E. SUNSET ROAD UNIT 96595
LAS VEGAS NV
89193-1246
US

V. Phone/Fax

Practice location:
  • Phone: 770-577-6739
  • Fax: 770-577-6743
Mailing address:
  • Phone: 702-798-0113
  • Fax: 866-291-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADE035095
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: STEVEN L RICHARDS
Title or Position: PRESIDENT
Credential:
Phone: 800-328-8602