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General NPI Number Information
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NPI Number | 1003875311
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Entity Type | Individual
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Provider Name | JACKIE L MILLER HADE, HIS
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4110 BRAINERD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37411-3700
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Country | US
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Telephone | 423-622-0087
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Fax | 423-622-7300
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Provider Business Mailing Address
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Address Line | 2009 ALBERMARLE DR
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City | HIXSON
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State | TN
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Zip | 37343-5912
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Country | US
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Telephone | 423-842-1396
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Fax | 423-842-0221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 561
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 687
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License Number State | GA
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