Provider Demographics
NPI:1972951317
Name:NORTHEAST GEORGIA HEARING AID CENTER LLC
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA HEARING AID CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARRAH
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:ESHAKSHUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-684-0731
Mailing Address - Street 1:165 TOWNE CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-2211
Mailing Address - Country:US
Mailing Address - Phone:706-684-0731
Mailing Address - Fax:
Practice Address - Street 1:165 TOWNE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-2211
Practice Address - Country:US
Practice Address - Phone:706-684-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA830332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment