Provider Demographics
NPI:1225179740
Name:AUDIOLOGICAL CONSULTANTS OF ATL.-BUCKHEAD, INC
Entity type:Organization
Organization Name:AUDIOLOGICAL CONSULTANTS OF ATL.-BUCKHEAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KADYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:404-351-4114
Mailing Address - Street 1:2140 PEACHTREE RD NW
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1314
Mailing Address - Country:US
Mailing Address - Phone:404-351-4114
Mailing Address - Fax:404-351-4223
Practice Address - Street 1:606 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4214
Practice Address - Country:US
Practice Address - Phone:770-229-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7554Medicare ID - Type Unspecified