Provider Demographics
NPI:1497727564
Name:ADVANCED HEARING & BALANCE CENTER
Entity Type:Organization
Organization Name:ADVANCED HEARING & BALANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-267-1569
Mailing Address - Street 1:3025 SHRINE RD STE 490
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4784
Mailing Address - Country:US
Mailing Address - Phone:912-267-1569
Mailing Address - Fax:912-261-8285
Practice Address - Street 1:3025 SHRINE RD STE 490
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4784
Practice Address - Country:US
Practice Address - Phone:912-267-1569
Practice Address - Fax:912-261-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003521231H00000X
GAAUD003627231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00888126CMedicaid
GA236146832AMedicaid
GA00888126BMedicaid
GA236146832AMedicaid