Provider Demographics
NPI:1063845246
Name:NORTH GEORGIA AUDIOLOGY AND HEARING AID CENTER, LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA AUDIOLOGY AND HEARING AID CENTER, LLC
Other - Org Name:JOHNS CREEK AUDIOLOGY AND HEARING AID CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:770-814-1260
Mailing Address - Street 1:4045 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1217
Mailing Address - Country:US
Mailing Address - Phone:770-814-1260
Mailing Address - Fax:770-814-1261
Practice Address - Street 1:4045 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1217
Practice Address - Country:US
Practice Address - Phone:770-814-1260
Practice Address - Fax:770-814-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD002017231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty