Healthcare Provider Details

I. General information

NPI: 1467475897
Provider Name (Legal Business Name): ELIAS M. HAWA M.C.H.,CCC-A,FAAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NEW TOWNE RD
BOWLING GREEN KY
42103-7966
US

IV. Provider business mailing address

340 NEW TOWNE RD
BOWLING GREEN KY
42103-7966
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-7768
  • Fax: 270-781-9480
Mailing address:
  • Phone: 270-782-7768
  • Fax: 270-781-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number161
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number8A
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number8
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: