Healthcare Provider Details

I. General information

NPI: 1043686405
Provider Name (Legal Business Name): STAN WARNER BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ACADEMY ST NW STE A
GAINESVILLE GA
30501-8524
US

IV. Provider business mailing address

200 W ACADEMY ST NW STE A
GAINESVILLE GA
30501-8524
US

V. Phone/Fax

Practice location:
  • Phone: 770-800-0041
  • Fax: 888-859-3046
Mailing address:
  • Phone: 770-800-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000776
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: