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General NPI Number Information
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NPI Number | 1497407324
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Entity Type | Organization
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Legal Business Name | HEARING AID FACTORY OUTLET LLC
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 5900 SUGARLOAF PKWY STE 423
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7848
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Country | US
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Telephone | 404-454-5460
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 SUGARLOAF PKWY STE 423
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7848
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GWENDOLYN CANTRELL
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Credential |
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Telephone | 404-454-5460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number |
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License Number State |
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