Provider Demographics
NPI:1841774957
Name:HANKLA, RYAN WAIDE (AUD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WAIDE
Last Name:HANKLA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 BOULEVARD SQ STE B
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-8032
Mailing Address - Country:US
Mailing Address - Phone:912-284-9200
Mailing Address - Fax:912-284-9887
Practice Address - Street 1:1705 BOULEVARD SQ STE B
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-8032
Practice Address - Country:US
Practice Address - Phone:912-284-9200
Practice Address - Fax:912-284-9887
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004150237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAUD004150OtherGEORGIA LICENSE NUMBER