Healthcare Provider Details

I. General information

NPI: 1306489851
Provider Name (Legal Business Name): ALEXIS GOLDBERG LOCKHART AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS BROOKE GOLDBERG AU.D.

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 LIGHTHOUSE MANOR DR
GAINESVILLE GA
30501-7401
US

IV. Provider business mailing address

2406 LIGHTHOUSE MANOR DR
GAINESVILLE GA
30501-7401
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-4352
  • Fax: 770-532-8165
Mailing address:
  • Phone: 770-536-4352
  • Fax: 770-532-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004211
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: