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General NPI Number Information
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NPI Number | 1164968152
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Entity Type | Organization
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Legal Business Name | PEACHTREE HEARING LLC
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 4939 LOWER ROSWELL RD STE 107A
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City | MARIETTA
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State | GA
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Zip | 30068-4382
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Country | US
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Telephone | 470-485-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 4939 LOWER ROSWELL RD STE 107A
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City | MARIETTA
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State | GA
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Zip | 30068-4382
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Country | US
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Telephone | 470-485-4327
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSHUA WIKOFF
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Credential |
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Telephone | 949-769-9286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AUD003887
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License Number State | GA
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