1467837468 NPI number — ATLANTA HEARING ASSOCIATES OF LAKE OCONEE, LLC

Table of content: (NPI 1467837468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467837468 NPI number — ATLANTA HEARING ASSOCIATES OF LAKE OCONEE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA HEARING ASSOCIATES OF LAKE OCONEE, 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:
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:
1467837468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 FIELDSTONE DR
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
MILLEDGEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31061-7106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-452-0578
Provider Business Mailing Address Fax Number:
478-453-0967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051 PARKSIDE CMNS
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30642-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-454-0578
Provider Business Practice Location Address Fax Number:
706-454-0575
Provider Enumeration Date:
07/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PRITCHETT
Authorized Official First Name:
JOY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
478-452-0578

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AUD000571 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com