Healthcare Provider Details

I. General information

NPI: 1174778930
Provider Name (Legal Business Name): WAITS SCIENTIFIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174A BANKS XING
FAYETTEVILLE GA
30214-7308
US

IV. Provider business mailing address

174A BANKS XING
FAYETTEVILLE GA
30214-7308
US

V. Phone/Fax

Practice location:
  • Phone: 770-461-0043
  • Fax: 770-460-7897
Mailing address:
  • Phone: 770-461-0043
  • Fax: 770-460-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD001514
License Number StateGA

VIII. Authorized Official

Name: DR. ANDREW DAVID WAITS
Title or Position: PRESDIENT
Credential: AU.D.
Phone: 770-461-0043