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General NPI Number Information
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NPI Number | 1841776689
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Entity Type | Individual
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Provider Name | SCOTT GUNTER BRUNSON HAD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 777 OLD ROSWELL PL # E100
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City | ROSWELL
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State | GA
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Zip | 30076
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Country | US
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Telephone | 770-910-9690
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 S PORT DR
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-5352
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Country | US
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Telephone | 404-427-0253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HADS000964
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License Number State | GA
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