Healthcare Provider Details

I. General information

NPI: 1194638247
Provider Name (Legal Business Name): RESTON AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTHRIDGE RD STE 400
SANDY SPRINGS GA
30350-3314
US

IV. Provider business mailing address

500 NORTHRIDGE RD STE 400
SANDY SPRINGS GA
30350-3314
US

V. Phone/Fax

Practice location:
  • Phone: 770-341-0282
  • Fax:
Mailing address:
  • Phone: 770-341-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY PERRY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 770-341-0282