Provider Demographics
NPI:1609043694
Name:NUSSBAUM, TONYA (AUD)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 SUWANEE DAM RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1951
Mailing Address - Country:US
Mailing Address - Phone:770-538-1818
Mailing Address - Fax:770-538-1718
Practice Address - Street 1:4320 SUWANEE DAM RD STE 200
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1951
Practice Address - Country:US
Practice Address - Phone:770-538-1818
Practice Address - Fax:770-538-1718
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003812237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter