Provider Demographics
NPI:1174864573
Name:COMBS, MICHAEL JOHN (HIS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:COMBS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FREE BRIDGE LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8446
Mailing Address - Country:US
Mailing Address - Phone:844-543-2782
Mailing Address - Fax:844-543-2782
Practice Address - Street 1:203 WEEPING WILLOW LN
Practice Address - Street 2:APT B
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-9242
Practice Address - Country:US
Practice Address - Phone:540-908-8910
Practice Address - Fax:844-543-2782
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001944237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist