=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710177761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE KIDD LLOYD HIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2007
-----------------------------------------------------
Last Update Date | 07/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 891 DAWSONVILLE HWY #140
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30501-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-287-0012
-----------------------------------------------------
Fax | 770-287-0018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3268 US HIGHWAY 441 S
-----------------------------------------------------
City | OKEECHOBEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34974-6239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-467-1286
-----------------------------------------------------
Fax | 863-763-9705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | HADS000734
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------