Provider Demographics
NPI:1063556272
Name:HEARCARE AUDIOLOGY
Entity type:Organization
Organization Name:HEARCARE AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HANKLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:912-284-9200
Mailing Address - Street 1:1705 BOULEVARD SQ STE B
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-8032
Mailing Address - Country:US
Mailing Address - Phone:912-284-9200
Mailing Address - Fax:912-284-9887
Practice Address - Street 1:1705 BOULEVARD SQ STE B
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501
Practice Address - Country:US
Practice Address - Phone:912-284-9200
Practice Address - Fax:912-284-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD000531231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055083858AMedicaid
GA000701984BMedicaid
GA000701984CMedicaid
GAR61602Medicare UPIN
GA640003838Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GAGRP3742Medicare ID - Type UnspecifiedMEDICARE GROUP
GA64BCBJFMedicare ID - Type UnspecifiedREGULAR MEDICARE