Provider Demographics
NPI:1265958078
Name:COVINGTON HEARING ASSOCIATES, LLC
Entity type:Organization
Organization Name:COVINGTON HEARING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:SUSANN
Authorized Official - Last Name:SHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-A, FAAA
Authorized Official - Phone:470-441-6333
Mailing Address - Street 1:4165 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2565
Mailing Address - Country:US
Mailing Address - Phone:470-441-6333
Mailing Address - Fax:470-389-6265
Practice Address - Street 1:4165 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2565
Practice Address - Country:US
Practice Address - Phone:470-441-6333
Practice Address - Fax:470-389-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000790072CMedicaid