Healthcare Provider Details

I. General information

NPI: 1649050782
Provider Name (Legal Business Name): SHEA R STROMBERG AU.D.- CCC-A/FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80A INTERSTATE SOUTH DR
JASPER GA
30143-6226
US

IV. Provider business mailing address

215 RIVERSTONE DR
CANTON GA
30114-5256
US

V. Phone/Fax

Practice location:
  • Phone: 770-345-6600
  • Fax: 770-345-6611
Mailing address:
  • Phone: 770-345-6600
  • Fax: 770-345-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51454
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003631
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: