Provider Demographics
NPI:1134481112
Name:NORTH EAST GEORGIA HEARING & BALANCE CLINIC
Entity type:Organization
Organization Name:NORTH EAST GEORGIA HEARING & BALANCE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:706-621-0387
Mailing Address - Street 1:355 CLEAR CREEK PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-4173
Mailing Address - Country:US
Mailing Address - Phone:706-356-0377
Mailing Address - Fax:
Practice Address - Street 1:355 CLEAR CREEK PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4173
Practice Address - Country:US
Practice Address - Phone:706-356-0377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD001447231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty