Provider Demographics
NPI:1891247821
Name:JAX AUDIOLOGY & HEARING AID CENTER, INC.
Entity Type:Organization
Organization Name:JAX AUDIOLOGY & HEARING AID CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NEWMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:404-697-7255
Mailing Address - Street 1:150 WARREN CIR
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 WARREN CIR
Practice Address - Street 2:SUITE 5A
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3845
Practice Address - Country:US
Practice Address - Phone:404-697-7255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1663231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty