Healthcare Provider Details

I. General information

NPI: 1225179740
Provider Name (Legal Business Name): AUDIOLOGICAL CONSULTANTS OF ATL.-BUCKHEAD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S 8TH ST
GRIFFIN GA
30224-4214
US

IV. Provider business mailing address

2140 PEACHTREE RD NW SUITE 350
ATLANTA GA
30309-1314
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6666
  • Fax:
Mailing address:
  • Phone: 404-351-4114
  • Fax: 404-351-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KADYN WILLIAMS
Title or Position: CO-DIRECTOR
Credential: AU.D.
Phone: 404-351-4114