Provider Demographics
NPI:1881815736
Name:GUEST, JOHNNY (LICENSED AID DEALER)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:GUEST
Suffix:
Gender:M
Credentials:LICENSED AID DEALER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 PARK ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-4638
Mailing Address - Country:US
Mailing Address - Phone:404-580-1982
Mailing Address - Fax:770-531-9559
Practice Address - Street 1:4730 HAMMOND INDUSTRIAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-3917
Practice Address - Country:US
Practice Address - Phone:770-887-8042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADE034820237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist