Healthcare Provider Details

I. General information

NPI: 1760290613
Provider Name (Legal Business Name): PROFESSIONAL AUDIOLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PARKWAY OFFICE CT STE 100
CARY NC
27518-7431
US

IV. Provider business mailing address

149 PLANTATION RIDGE DR STE 140
MOORESVILLE NC
28117-9175
US

V. Phone/Fax

Practice location:
  • Phone: 919-851-3800
  • Fax: 704-251-6746
Mailing address:
  • Phone: 704-360-4788
  • Fax: 704-251-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: JOEL PARKER
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 479-422-6890