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General NPI Number Information
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NPI Number | 1548751589
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Entity Type | Individual
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Provider Name | TIFFANY ROE HANKLA AU.D.
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Gender | Female
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 1705 BOULEVARD SQ STE B
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City | WAYCROSS
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State | GA
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Zip | 31501
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Country | US
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Telephone | 912-284-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 BOULEVARD SQ STE B
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City | WAYCROSS
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State | GA
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Zip | 31501-8032
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Country | US
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Telephone | 912-284-9200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AUD004130
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AUD004130
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License Number State | GA
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