Provider Demographics
NPI:1598145567
Name:RYAN, AUSTIN (HAS,HIS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:HAS,HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956A DAWSONVILLE HWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-536-5552
Mailing Address - Fax:
Practice Address - Street 1:956A DAWSONVILLE HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-536-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000929237700000X
SCHAS-0553237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist