=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073870168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARING CENTER OF WILKES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2012
-----------------------------------------------------
Last Update Date | 04/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 9TH ST SUITE B
-----------------------------------------------------
City | NORTH WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28659-4169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-667-4700
-----------------------------------------------------
Fax | 336-667-4727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 9TH ST SUITE B
-----------------------------------------------------
City | NORTH WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28659-4169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-667-4700
-----------------------------------------------------
Fax | 336-667-4727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF AUDIOLOGY/OWNER
-----------------------------------------------------
Name | DR. CHRISTY MAHAN BROWN
-----------------------------------------------------
Credential | AU.D., CCC-A, FAAA
-----------------------------------------------------
Telephone | 336-667-4700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 7604
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------