Provider Demographics
NPI:1720357684
Name:THE HEARING CENTER AT ATHENS EYE
Entity Type:Organization
Organization Name:THE HEARING CENTER AT ATHENS EYE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-549-7047
Mailing Address - Street 1:1080 VEND DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-3051
Mailing Address - Country:US
Mailing Address - Phone:706-549-7047
Mailing Address - Fax:
Practice Address - Street 1:1080 VEND DR STE 100
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-3051
Practice Address - Country:US
Practice Address - Phone:706-549-7047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENS EYE ASSOCAITES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053926332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment