Healthcare Provider Details

I. General information

NPI: 1477040657
Provider Name (Legal Business Name): STEVENSON HEARING HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N MARIETTA PKWY NE STE E
MARIETTA GA
30060-8023
US

IV. Provider business mailing address

145 N MARIETTA PKWY NE STE E
MARIETTA GA
30060-8023
US

V. Phone/Fax

Practice location:
  • Phone: 770-590-8662
  • Fax:
Mailing address:
  • Phone: 770-590-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHADS000963
License Number StateGA

VIII. Authorized Official

Name: MR. JOHN MARK STEVENSON SR.
Title or Position: OWNER / HAD
Credential:
Phone: 770-590-8662