Healthcare Provider Details

I. General information

NPI: 1205837705
Provider Name (Legal Business Name): JIOVANNE NEAL HUGHART AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 OLDE TOWNE PKWY STE 360
MARIETTA GA
30068-4357
US

IV. Provider business mailing address

4800 OLDE TOWNE PKWY STE 360
MARIETTA GA
30068-4357
US

V. Phone/Fax

Practice location:
  • Phone: 770-971-1533
  • Fax: 770-971-4846
Mailing address:
  • Phone: 770-971-1533
  • Fax: 770-971-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number937
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: