Provider Demographics
NPI:1972772200
Name:ADDISON, C. LEWIS (CCC-A, FAAA)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:LEWIS
Last Name:ADDISON
Suffix:
Gender:M
Credentials: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 1:3310 ALTA VISTA DR
Mailing Address - Street 2:HEARTECH, LLC
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4201
Mailing Address - Country:US
Mailing Address - Phone:423-785-7803
Mailing Address - Fax:
Practice Address - Street 1:3310 ALTA VISTA DR
Practice Address - Street 2:HEARTECH, LLC
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4201
Practice Address - Country:US
Practice Address - Phone:423-785-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA 0000000082237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter