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General NPI Number Information
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NPI Number | 1811552276
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Entity Type | Organization
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Legal Business Name | EARSOURCE TECHNOLOGIES LLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 301 FLORENCE AVE
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City | STATESBORO
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State | GA
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Zip | 30458-5138
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Country | US
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Telephone | 912-764-6150
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Fax | 912-489-5866
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Provider Business Mailing Address
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Address Line | 301 FLORENCE AVE
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City | STATESBORO
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State | GA
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Zip | 30458-5138
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Country | US
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Telephone | 912-764-6150
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Fax | 912-489-5866
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM WARREN PERRINE
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Credential | CCC-A
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Telephone | 912-764-6150
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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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