Provider Demographics
NPI:1154331676
Name:STACK, ANDREA HOOD (AUD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:HOOD
Last Name:STACK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:HOOD
Other - Last Name:STACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:1101 HOSPITAL DR
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9075
Mailing Address - Country:US
Mailing Address - Phone:770-474-7416
Mailing Address - Fax:
Practice Address - Street 1:1101 HOSPITAL DR
Practice Address - Street 2:SUITE 100A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9075
Practice Address - Country:US
Practice Address - Phone:770-474-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003791231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist