=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831791136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGH LEVEL SPEECH & HEARING CENTER OF ATLANTA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2020
-----------------------------------------------------
Last Update Date | 11/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3372 PEACHTREE RD NE STE 115
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30326-1881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-308-0688
-----------------------------------------------------
Fax | 504-702-8441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3372 PEACHTREE RD NE STE 115
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30326-1881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-308-0688
-----------------------------------------------------
Fax | 504-702-8441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LANA JOSEPH
-----------------------------------------------------
Credential | AUD
-----------------------------------------------------
Telephone | 504-308-0688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------