MEDICARE: BEN A. HARRISON HAD

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	HADS000948	GA

General Provider Information

NPI Number	:	1982059424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN A. HARRISON HAD

Provider Business Mailing Address
First Line	:	1001 E. SUNSET ROAD
Second Line	:	UNIT 96595
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-1246
Country	:	US
Telephone Number	:	702-798-0113
Fax Number	:	866-291-5242

Provider Business Practice Location Address
First Line	:	2326 WARM SPRINGS RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	GA
Zip	:	31904-6860
Country	:	US
Telephone Number	:	706-576-5555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	05/03/2016

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