Healthcare Provider Details

I. General information

NPI: 1790153583
Provider Name (Legal Business Name): MOBILE HEARING OF TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STONE CHIMNEY CT
NASHVILLE TN
37214-4736
US

IV. Provider business mailing address

12910 SHELBYVILLE RD STE 300
LOUISVILLE KY
40243-2404
US

V. Phone/Fax

Practice location:
  • Phone: 855-259-9183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1444
License Number StateTN

VIII. Authorized Official

Name: JENNIFER ROMINE MCGLOTHLIN
Title or Position: OWNER
Credential: AU.D
Phone: 855-259-9183