Provider Demographics
NPI:1144926452
Name:GEORGIA HEARING AID OUTLET
Entity type:Organization
Organization Name:GEORGIA HEARING AID OUTLET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:III
Authorized Official - Credentials:HIS, HHCP,SMHP,
Authorized Official - Phone:678-541-5605
Mailing Address - Street 1:3333 BUFORD DR STE 1098
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4936
Mailing Address - Country:US
Mailing Address - Phone:678-541-5605
Mailing Address - Fax:678-541-5605
Practice Address - Street 1:3333 BUFORD DR STE 1098
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4936
Practice Address - Country:US
Practice Address - Phone:678-541-5605
Practice Address - Fax:678-541-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech