Provider Demographics
NPI:1184104358
Name:LOVELACE, THOMAS CHARLES (HADS,HIS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:HADS,HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 HIGHWAY 515 W STE D
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-7830
Mailing Address - Country:US
Mailing Address - Phone:706-745-0091
Mailing Address - Fax:706-745-0099
Practice Address - Street 1:411 HIGHWAY 515 W STE D
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-7830
Practice Address - Country:US
Practice Address - Phone:706-745-0091
Practice Address - Fax:706-745-0099
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000892237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist