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General NPI Number Information
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NPI Number | 1780693481
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Entity Type | Organization
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Legal Business Name | AUGUSTA HEARING AND BALANCE
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1215 GEORGE C WILSON DR SUITE 3A
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City | AUGUSTA
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State | GA
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Zip | 30909-5700
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Country | US
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Telephone | 706-364-2378
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 GEORGE C WILSON DR SUITE 3A
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City | AUGUSTA
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State | GA
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Zip | 30909-5700
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Country | US
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Telephone | 706-364-2378
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | DR. EDGAR ROBIN BOHANNON
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Credential |
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Telephone | 706-364-2378
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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 | AUD0065
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License Number State | GA
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