Provider Demographics
NPI:1154760908
Name:AUDIOLOGY CENTER OF SNELLVILLE LLC
Entity type:Organization
Organization Name:AUDIOLOGY CENTER OF SNELLVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:VAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:770-972-4327
Mailing Address - Street 1:2176 OAK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2374
Mailing Address - Country:US
Mailing Address - Phone:770-972-4327
Mailing Address - Fax:770-972-4101
Practice Address - Street 1:2176 OAK RD
Practice Address - Street 2:SUITE C
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2374
Practice Address - Country:US
Practice Address - Phone:770-972-4327
Practice Address - Fax:770-972-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003479231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA64BCBPMMedicare PIN