Provider Demographics
NPI:1184988891
Name:JKL HEARING CENTER, INC
Entity type:Organization
Organization Name:JKL HEARING CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-519-6400
Mailing Address - Street 1:PO BOX 450264
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31145-0264
Mailing Address - Country:US
Mailing Address - Phone:770-519-6400
Mailing Address - Fax:770-814-9772
Practice Address - Street 1:4195 S LEE ST
Practice Address - Street 2:SUITE A
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8019
Practice Address - Country:US
Practice Address - Phone:678-714-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JKL HEARING CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADE034859332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment