Provider Demographics
NPI:1922262823
Name:AUDIOLOGY ASSOCIATES OF GEORGIA, INC
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES OF GEORGIA, INC
Other - Org Name:AUDIOLOGY ASSOCIATES OF GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:770-717-5711
Mailing Address - Street 1:4145 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:STE. 10A
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2807
Mailing Address - Country:US
Mailing Address - Phone:770-717-5711
Mailing Address - Fax:770-717-5612
Practice Address - Street 1:4145 LAWRENCEVILLE HWY NW
Practice Address - Street 2:STE. 10A
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2807
Practice Address - Country:US
Practice Address - Phone:770-717-5711
Practice Address - Fax:770-717-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1032237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00373029CMedicaid
GA00668533CMedicaid
1538228465OtherNPI
1538228465OtherNPI