Healthcare Provider Details

I. General information

NPI: 1821091844
Provider Name (Legal Business Name): MICHELLE HAMES STONE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/21/2022
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 EAGLES LANDING PKWY STE 201
STOCKBRIDGE GA
30281-9082
US

IV. Provider business mailing address

1260 HIGHWAY 54 W STE 203
FAYETTEVILLE GA
30214-4513
US

V. Phone/Fax

Practice location:
  • Phone: 770-507-0384
  • Fax: 770-507-4629
Mailing address:
  • Phone: 770-631-1833
  • Fax: 770-461-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD0003986
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number760A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: