Healthcare Provider Details

I. General information

NPI: 1467107565
Provider Name (Legal Business Name): WILLIAM LEO MARTIN II HEARING CARE PROVIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HOUZE WAY STE B3
ROSWELL GA
30076-1432
US

IV. Provider business mailing address

600 HOUZE WAY STE B3
ROSWELL GA
30076-1432
US

V. Phone/Fax

Practice location:
  • Phone: 770-641-9087
  • Fax: 678-884-0431
Mailing address:
  • Phone: 770-641-9087
  • Fax: 678-884-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000794
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: