1578166476 NPI number — GEORGIA HEARING AID FACTORY OUTLET, INC.

Table of content: SARAH ALETHEA DE LOS SANTOS PSY.D. (NPI 1962650242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578166476 NPI number — GEORGIA HEARING AID FACTORY OUTLET, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA HEARING AID FACTORY OUTLET, INC.
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:
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:
1578166476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 HIGHWAY 400 S STE 525
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAWSONVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30534-6894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-868-6036
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 ERNEST W BARRETT PKWY NW STE 168
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-4952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-525-9907
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUMGARNER
Authorized Official First Name:
BRITTANY
Authorized Official Middle Name:
MICHELE
Authorized Official Title or Position:
HIS
Authorized Official Telephone Number:
770-868-6036

Provider Taxonomy Codes

  • Taxonomy code: 237700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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