1144774373 NPI number — NORTH GEORGIA AUDIOLOGY AND HEARING AID CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144774373 NPI number — NORTH GEORGIA AUDIOLOGY AND HEARING AID CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH GEORGIA AUDIOLOGY AND HEARING AID CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144774373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4045 JOHNS CREEK PKWY STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024-1218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-814-1260
Provider Business Mailing Address Fax Number:
770-234-6977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
726 SOUTH ENOTA DRIVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-971-4647
Provider Business Practice Location Address Fax Number:
678-971-4648
Provider Enumeration Date:
08/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WOODWARD
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
TRAUTH
Authorized Official Title or Position:
DOCTOR OF AUDIOLOGY
Authorized Official Telephone Number:
770-814-1260

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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