Healthcare Provider Details

I. General information

NPI: 1518566314
Provider Name (Legal Business Name): CAPITAL HEARING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 LAKELAND EAST DR STE A
FLOWOOD MS
39232-9565
US

IV. Provider business mailing address

628 LAKELAND EAST DR STE A
FLOWOOD MS
39232-9565
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-9595
  • Fax: 601-939-9504
Mailing address:
  • Phone: 601-939-9595
  • Fax: 601-939-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID DOTY
Title or Position: MANAGER
Credential:
Phone: 601-939-9595