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General NPI Number Information
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NPI Number | 1265807358
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Entity Type | Organization
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Legal Business Name | MOBILE HEARING OF GEORGIA, LLC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 2021 SCOTT RD
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City | AUGUSTA
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State | GA
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Zip | 30906-2539
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Country | US
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Telephone | 706-793-1057
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Fax |
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Provider Business Mailing Address
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Address Line | 12910 SHELBYVILLE RD SUITE 300
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City | LOUISVILLE
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State | KY
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Zip | 40243-1593
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Country | US
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Telephone | 502-244-2441
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Fax | 502-254-4069
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Authorized Official
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Title or Position | OWNER
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Name | JASON P WIGAND
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Credential | AUD
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Telephone | 855-259-9183
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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 |
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License Number State |
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