Provider Demographics
NPI:1477715902
Name:AUDIOLOGY AT HOME
Entity Type:Organization
Organization Name:AUDIOLOGY AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOODOO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:770-493-8430
Mailing Address - Street 1:3939 LAVISTA RD STE E
Mailing Address - Street 2:#390
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5162
Mailing Address - Country:US
Mailing Address - Phone:770-493-8430
Mailing Address - Fax:770-493-8433
Practice Address - Street 1:2789 CLAIRMONT RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2700
Practice Address - Country:US
Practice Address - Phone:770-493-8430
Practice Address - Fax:770-493-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty