Healthcare Provider Details

I. General information

NPI: 1306085410
Provider Name (Legal Business Name): ALBEMARLE AUDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CAMDEN CSWY SUITE C
ELIZABETH CITY NC
27909-6811
US

IV. Provider business mailing address

PO BOX 2443
ELIZABETH CITY NC
27906-2443
US

V. Phone/Fax

Practice location:
  • Phone: 252-331-2437
  • Fax: 252-331-0308
Mailing address:
  • Phone: 252-331-1494
  • Fax: 252-331-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number841
License Number StateVA

VIII. Authorized Official

Name: MR. THOMAS J HENDERSON
Title or Position: PRESIDENT
Credential: M.S., CCC-A
Phone: 252-331-1494