Provider Demographics
NPI:1306489851
Name:LOCKHART, ALEXIS GOLDBERG (AUD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:GOLDBERG
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:BROOKE
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2406 LIGHTHOUSE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7401
Mailing Address - Country:US
Mailing Address - Phone:770-536-4352
Mailing Address - Fax:770-532-8165
Practice Address - Street 1:2406 LIGHTHOUSE MANOR DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7401
Practice Address - Country:US
Practice Address - Phone:770-536-4352
Practice Address - Fax:770-532-8165
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004211231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist