Provider Demographics
NPI:1659243483
Name:SOUTH ATLANTIC HEARING LLC
Entity type:Organization
Organization Name:SOUTH ATLANTIC HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORRIDORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-741-2182
Mailing Address - Street 1:12420 FAIRWOOD PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6360
Mailing Address - Country:US
Mailing Address - Phone:240-245-3353
Mailing Address - Fax:
Practice Address - Street 1:8801 CENTRE PARK DR STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2134
Practice Address - Country:US
Practice Address - Phone:240-245-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty