Provider Demographics
NPI:1972610327
Name:BOODOO, CORINNE (MS, CCC-A, FAAA)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:BOODOO
Suffix:
Gender:F
Credentials:MS, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 LAVISTA RD STE E390
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5162
Mailing Address - Country:US
Mailing Address - Phone:770-493-8430
Mailing Address - Fax:770-493-8433
Practice Address - Street 1:2789 CLAIRMONT RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2700
Practice Address - Country:US
Practice Address - Phone:770-493-8430
Practice Address - Fax:770-493-8433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1772231H00000X, 237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist