Provider Demographics
NPI:1548825565
Name:GEORGIA HEARING AID FACTORY OUTLET
Entity type:Organization
Organization Name:GEORGIA HEARING AID FACTORY OUTLET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BUMGARNER
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:770-868-6036
Mailing Address - Street 1:800 HIGHWAY 400 S STE 525
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6894
Mailing Address - Country:US
Mailing Address - Phone:770-868-6036
Mailing Address - Fax:
Practice Address - Street 1:800 HIGHWAY 400 S STE 525
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6894
Practice Address - Country:US
Practice Address - Phone:770-868-6036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty