Provider Demographics
NPI:1477040657
Name:STEVENSON HEARING HEALTHCARE, LLC
Entity Type:Organization
Organization Name:STEVENSON HEARING HEALTHCARE, LLC
Other - Org Name:AMERICAN FAMILY HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / HAD
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:770-590-8662
Mailing Address - Street 1:145 N MARIETTA PKWY NE STE E
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8023
Mailing Address - Country:US
Mailing Address - Phone:770-590-8662
Mailing Address - Fax:
Practice Address - Street 1:145 N MARIETTA PKWY NE STE E
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8023
Practice Address - Country:US
Practice Address - Phone:770-590-8662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000963332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA035185274OtherDL