Provider Demographics
NPI:1710285705
Name:WHITCOMB, KEITH A (HAD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:WHITCOMB
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E. SUNSET ROAD
Mailing Address - Street 2:UNIT 96595
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-1246
Mailing Address - Country:US
Mailing Address - Phone:702-798-0113
Mailing Address - Fax:866-291-5242
Practice Address - Street 1:103 SAMARITAN DR
Practice Address - Street 2:UNIT C
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2465
Practice Address - Country:US
Practice Address - Phone:770-888-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000851237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist