Provider Demographics
NPI:1063677664
Name:SOUTHEASTERN AUDIOLOGY, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN AUDIOLOGY, INC.
Other - Org Name:SOUTHEASTERN AUDIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:912-352-8530
Mailing Address - Street 1:527 STEPHENSON AVE
Mailing Address - Street 2:A-3
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5923
Mailing Address - Country:US
Mailing Address - Phone:912-352-8530
Mailing Address - Fax:
Practice Address - Street 1:527 STEPHENSON AVE
Practice Address - Street 2:A-3
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-352-8530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD3780231H00000X
SCAUD 3899231H00000X, 231HA2400X, 237600000X
GAAUD 3780231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA337091148Medicaid