Provider Demographics
NPI:1811552276
Name:EARSOURCE TECHNOLOGIES LLC
Entity Type:Organization
Organization Name:EARSOURCE TECHNOLOGIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:PERRINE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-A
Authorized Official - Phone:912-764-6150
Mailing Address - Street 1:301 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5138
Mailing Address - Country:US
Mailing Address - Phone:912-764-6150
Mailing Address - Fax:912-489-5866
Practice Address - Street 1:301 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5138
Practice Address - Country:US
Practice Address - Phone:912-764-6150
Practice Address - Fax:912-489-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty