Healthcare Provider Details

I. General information

NPI: 1386851459
Provider Name (Legal Business Name): ANDREW DAVID WAITS AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174A BANKS XING
FAYETTEVILLE GA
30214-7308
US

IV. Provider business mailing address

681 S 9TH ST
GRIFFIN GA
30224-4215
US

V. Phone/Fax

Practice location:
  • Phone: 770-461-0043
  • Fax: 770-460-7897
Mailing address:
  • Phone: 770-228-5745
  • Fax: 770-228-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD001514
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: