Healthcare Provider Details

I. General information

NPI: 1619551884
Provider Name (Legal Business Name): INNOVATIVE HEARING SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MCEVER RD
GAINESVILLE GA
30504-5539
US

IV. Provider business mailing address

3000 MCEVER RD
GAINESVILLE GA
30504-5539
US

V. Phone/Fax

Practice location:
  • Phone: 678-696-5470
  • Fax: 678-696-5482
Mailing address:
  • Phone: 678-696-5470
  • Fax: 678-696-5482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER VINCENT CAMPELLONE
Title or Position: CEO
Credential: HIS-PROVIDER
Phone: 678-696-5470