Provider Demographics
NPI:1386851459
Name:WAITS, ANDREW DAVID (AUD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
Last Name:WAITS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4215
Mailing Address - Country:US
Mailing Address - Phone:770-228-5745
Mailing Address - Fax:770-228-5317
Practice Address - Street 1:174A BANKS XING
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7308
Practice Address - Country:US
Practice Address - Phone:770-461-0043
Practice Address - Fax:770-460-7897
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD001514237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581802895OtherTAX ID#
GAAUD001514OtherSTATE LICENSE NO.