Healthcare Provider Details

I. General information

NPI: 1629168414
Provider Name (Legal Business Name): ANDERSON AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CLEBURNE BLVD
DUBLIN VA
24084-4435
US

IV. Provider business mailing address

85 CLEBURNE BLVD
DUBLIN VA
24084-4435
US

V. Phone/Fax

Practice location:
  • Phone: 540-674-4889
  • Fax: 540-674-1666
Mailing address:
  • Phone: 540-674-4889
  • Fax: 540-674-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2201000588
License Number StateVA

VIII. Authorized Official

Name: DR. JANICE ANDERSON
Title or Position: PRESIDENT
Credential: AUDIOLOGIST
Phone: 540-674-4889