Healthcare Provider Details

I. General information

NPI: 1942560875
Provider Name (Legal Business Name): HEARING AID SERVICES OF ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 HIGHWAY 54 W
FAYETTEVILLE GA
30214-4557
US

IV. Provider business mailing address

1240 HIGHWAY 54 W
FAYETTEVILLE GA
30214-4557
US

V. Phone/Fax

Practice location:
  • Phone: 770-461-7002
  • Fax:
Mailing address:
  • Phone: 770-461-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberHADE034979
License Number StateGA

VIII. Authorized Official

Name: MRS. BARBARA J STOCK
Title or Position: PRESIDET
Credential: HIS
Phone: 770-461-7002