Provider Demographics
NPI:1952437055
Name:FAYETTE HEARING CLINIC INC
Entity Type:Organization
Organization Name:FAYETTE HEARING CLINIC INC
Other - Org Name:FAYETTE HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:770-631-4490
Mailing Address - Street 1:100 GENEVIEVE CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-4803
Mailing Address - Country:US
Mailing Address - Phone:770-631-4490
Mailing Address - Fax:770-631-4495
Practice Address - Street 1:100 GENEVIEVE CT
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-4803
Practice Address - Country:US
Practice Address - Phone:770-631-4490
Practice Address - Fax:770-631-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003619231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty