Provider Demographics
NPI:1821167487
Name:SHOALS AUDIOLOGY
Entity Type:Organization
Organization Name:SHOALS AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOCKETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-314-6673
Mailing Address - Street 1:1114 BRADSHAW DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1438
Mailing Address - Country:US
Mailing Address - Phone:256-764-2667
Mailing Address - Fax:
Practice Address - Street 1:1114 BRADSHAW DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1438
Practice Address - Country:US
Practice Address - Phone:256-764-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL617A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ26382Medicare UPIN