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	237700000X	Hearing Instrument Specialist	HAD591	GA

General Provider Information

NPI Number	:	1770780074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JKL HEARING CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 450264
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31145-0264
Country	:	US
Telephone Number	:	770-493-3256
Fax Number	:	770-814-9772

Provider Business Practice Location Address
First Line	:	2201 HENDERSON MILL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2711
Country	:	US
Telephone Number	:	770-493-3256
Fax Number	:	770-814-9772

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANE LEWIS
Credential	:
Telephone Number	:	770-493-3256

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	08/22/2020

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