Provider Demographics
NPI:1427401736
Name:GORMAN, TREY
Entity Type:Individual
Prefix:
First Name:TREY
Middle Name:
Last Name:GORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3701
Mailing Address - Country:US
Mailing Address - Phone:205-822-0700
Mailing Address - Fax:
Practice Address - Street 1:2300 ROSWELL RD STE 110
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4952
Practice Address - Country:US
Practice Address - Phone:770-919-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000919237700000X
AL2229237700000X
MSHA0587237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist