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General NPI Number Information
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NPI Number | 1679333611
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Entity Type | Organization
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Legal Business Name | MIDDLE GEORGIA AUDIOLOGY LLC
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 524 S HOUSTON LAKE RD STE E100
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City | WARNER ROBINS
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State | GA
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Zip | 31088-9059
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Country | US
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Telephone | 478-235-5836
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Fax | 478-239-5146
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Provider Business Mailing Address
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Address Line | 524 S HOUSTON LAKE RD STE E100
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City | WARNER ROBINS
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State | GA
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Zip | 31088-9059
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Country | US
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Telephone | 478-235-5836
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Fax | 478-239-5146
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATALIE PETERSON GIBBS
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Credential | AUD
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Telephone | 478-235-5836
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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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