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

Table of content: (NPI 1144774373)

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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