Provider Demographics
NPI:1184795221
Name:ATLANTA HEARING DOCTOR
Entity type:Organization
Organization Name:ATLANTA HEARING DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-252-7228
Mailing Address - Street 1:5885 GLENRIDGE DRIVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5512
Mailing Address - Country:US
Mailing Address - Phone:404-252-7528
Mailing Address - Fax:404-480-8842
Practice Address - Street 1:5885 GLENRIDGE DRIVE
Practice Address - Street 2:SUITE 155
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5512
Practice Address - Country:US
Practice Address - Phone:404-252-7528
Practice Address - Fax:404-480-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD001278231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty