Healthcare Provider Details

I. General information

NPI: 1770774044
Provider Name (Legal Business Name): AUDIOLOGICAL CONSULTANTS OF ATLANTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2007
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 SUGARLOAF PKWY SUITE 800
DULUTH GA
30097-4344
US

IV. Provider business mailing address

6600 SUGARLOAF PKWY SUITE 800
DULUTH GA
30097-4344
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-3005
  • Fax:
Mailing address:
  • Phone: 770-476-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: KADYN O WILLIAMS
Title or Position: CO-DIRECTOR
Credential: AU.D.
Phone: 404-256-5194