Provider Demographics
NPI:1225382104
Name:ANDREW, RYNDA KAY (BC -HIS)
Entity type:Individual
Prefix:MRS
First Name:RYNDA
Middle Name:KAY
Last Name:ANDREW
Suffix:
Gender:F
Credentials:BC -HIS
Other - Prefix:
Other - First Name:RYNDA
Other - Middle Name:KAY
Other - Last Name:TONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 EDGEWATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223
Mailing Address - Country:US
Mailing Address - Phone:281-745-7471
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80427237700000X
GAHADS000972237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80427OtherFITTER AND DISPENSER LICENSE