=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245575489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLE LISTENERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2012
-----------------------------------------------------
Last Update Date | 03/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6720 JAMESTOWN DR
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-744-2451
-----------------------------------------------------
Fax | 770-573-6399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6720 JAMESTOWN DR
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-744-2451
-----------------------------------------------------
Fax | 770-573-6399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST/OWNER
-----------------------------------------------------
Name | DR. CHRISTA BOYETT REEVES
-----------------------------------------------------
Credential | AU.D.
-----------------------------------------------------
Telephone | 770-744-2451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | 003546
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------