MEDICARE: JKL HEARING CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment	HADE034937	GA

General Provider Information

NPI Number	:	1558646471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JKL HEARING CENTER, INC

Provider Business Mailing Address
First Line	:	2114 HENDERSON MILL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3762
Country	:	US
Telephone Number	:	770-934-4327
Fax Number	:	770-814-9772

Provider Business Practice Location Address
First Line	:	2114 HENDERSON MILL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3762
Country	:	US
Telephone Number	:	770-934-4327
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JANE L LEWIS
Credential	:
Telephone Number	:	770-519-6400

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	10/12/2011

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